National Quality Auditor - RN – Louisville

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.

Role: National Quality Auditor, Clinical Operations
Location: Louisville, KY

Are you a fit?
Are you an analytical thinker with sound organizational skills? Do you believe in the value of exceptional customer service - that every transaction should be done right the first time and that every error is a learning experience?

Assignment Capsule:
As a National Quality Auditor, you will be responsible for conducting audits of phone calls, documentation, and other work performed by the Humana Clinical Programs (Personal Nurse, Humana Beginnings, Case Management, Transplant, and Bariatric). These Clinical Programs provide member-focused health services to address specific conditions. Some of the primary functions of the position will be:

• Effectively perform routine audits of the Clinical Programs' functions utilizing standardized tool.
  
• Provide audit feedback to associates, Clinical Program leadership and Clinical Operations management.
  
• Compile and distribute regular reports of audit findings.
  
• Calibrate regularly with fellow auditors to ensure quality and consistency.
  
• Detect opportunities for training or re-training of associates and collaborate effectively with trainers to implement optimal training.
  
• Perform focused audits based on needs identified by senior management.
  
• Assist in regular analysis of the audit role and all relevant processes.
  
• Identify and implement process improvements opportunities.

Key Competencies:

• Champions the Customer: You keep closely attuned to the needs and perspectives of customers and use this insight for the benefit of the business.
  
• Drives for Excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.
  
• Communication: You actively listen to others to understand their perspective. You understand that you must tailor your delivery according to your audience. You are able to present information and/or recommendations verbally, graphically, and/or in writing that is articulate and succinct.
  
• Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.

Role Essentials:

• Active RN license in KY and the ability to be licensed in multiple states without restrictions
  
• Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
  
• Ability to work independently under general instructions and with a team
  
• Excellent PC skills (including MS Word, Excel, Access, PowerPoint)
  
• Capacity to maintain confidentiality

Role Desirables:
The best candidates for this position will:

• Be comfortable with electronic technology. From the telephone to the computer, the auditor chooses and adeptly uses appropriate technology tools, methodologies and solutions.
  
• Have sound assessment skills. The auditor assesses data, trends, and information gathered from quality audits to produce improved outcomes for members, providers, and Humana.
  
• Recognize issues and escalates appropriately.
  
• Be bilingual (Spanish).
  
• Bachelor's degree
  
• Have experience with Humana systems and with quality or process improvement approaches.

Reporting Relationship:
The auditor will report to a Clinical Operations Process Development Consultant. This area is under the leadership of the Clinical Guidance Organization.

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