RN, Quality Assurance Professional

RN, Quality Assurance Professional 2

The RN, Quality Assurance Professional 2 serves as a clinical subject matter expert within Internal Audit, supporting audits across Center Well, Care Management, Utilization Management, and other healthcare operations. You will work closely with audit professionals and business leaders and play a critical role in identifying opportunities for improvement, strengthening processes, and supporting Humana's commitment to high-quality care, accountability, and continuous improvement.

The ideal candidate brings a strong clinical background and a passion for improving healthcare quality and outcomes through objective analysis and problem-solving. This unique role offers an opportunity to apply nursing expertise beyond direct patient care by influencing enterprise-wide improvements in clinical operations, regulatory compliance, and risk management.

Serve as the clinical subject matter expert supporting Internal Audit engagements across Center Well, Care Management, Utilization Management, and other healthcare delivery functions.

Partner with audit professionals to provide clinical insight during audit planning, testing, and reporting activities, helping evaluate the effectiveness of key processes, controls, and compliance with regulatory, contractual, and organizational requirements.

Reviews clinical documentation, operational workflows, and quality management activities to identify potential risks, evaluate the effectiveness of controls, and recommend process improvements that enhance compliance, quality, and operational performance.

Use your skills to make an impact

Required Qualifications

• An active, unrestricted, RN license.
• Minimum of 3 years of clinical nursing experience, with demonstrated knowledge of care management, utilization management, population health, or healthcare operations.
• Experience reviewing clinical documentation, healthcare processes, and operational workflows to assess compliance, quality, and effectiveness.
• Knowledge of healthcare regulations, accreditation standards, and industry best practices, including CMS, NCQA, URAC or state and federal requirements.
• Proficient in Microsoft Office Suite, including Word, Excel, and PowerPoint with the ability to support operational and audit activities.
• Strong written and oral communication skills, with the ability to prepare clear, concise reports and collaborate effectively with stakeholders at all levels of the organization.

Preferred Qualifications

• Certification in Healthcare Quality (CPHQ), Case Management (CCM), Utilization Management (CPUM), Internal Auditing (CIA), or related discipline.
• Experience in managed care or health care administration.
• Experience participating in audits, assessments, quality reviews, or compliance monitoring activities within care management, utilization management, or healthcare operations.

Additional Information

• Workstyle: This is a remote position.
• Travel: Up to 5% travel is required for team engagement meetings, which may occur outside your state of residence.
• Typical Workdays and Hours: Monday – Friday; 8:00AM – 5:00 PM Eastern Time (ET).

Work at Home Requirements:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively,…