Location
Tampa, FL, United States
Posted on
Dec 20, 2022
Profile
Description
Humana is seeking an Associate Director, Quality Compliance Nursing that works with physicians/physician groups to ensure highest accountability of compliance and quality. The Associate Director, Quality Compliance Nursing requires a solid understanding of how organization capabilities interrelate across department(s).
Take advantage of Humana's competitive pay, lucrative 401k matching programs and more! Apply now to begin your future with a Fortune 500 Company!
Responsibilities
The Associate Director, Quality Compliance Nursing:
Reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse
Ensures mandatory reporting completed within designated timeframes
Conducts and summarizes compliance audits
Collects and analyzes data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals
Could lead multiple managers or highly specialized professional associates
Grow talent and strengthen key capabilities in the organization to prepare Humana for rapid change and sustainability, to advance an inclusive and engaging environment, and to deliver outstanding outcomes for customers and stakeholders
Collaborates timely and effectively with cross functional leaders and teams to meet goals and deliver excellence
Develop multi-pronged approach to address quality opportunities (ex. HEDIS measures, performance improvement projects, etc.) with input and engagement of providers, internal staff, and community partners
Decisions are typically related to identifying and resolving complex technical and operational problems within department(s)
Required Qualifications
Must reside in Florida
Florida licensed registered nurse, advanced practice registered nurse, or certified professional in Health Care Quality (CPHQ) by the National Association for Healthcare Quality
Bachelor's degree in nursing, public health, health administration, health policy or business
6 or more years of technical experience
2 or more years of management experience
Experience with NCQA Standards
Experience working with Medicare, Medicaid and dual-eligible populations
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Preferred Qualifications
CPHQ certification (or other recognized Quality certification)
Audit experience
Knowledge of working with Florida contracts
Additional Information
A modest amount of travel (generally 10% or less) should be expected.
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****
Company info
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