Description

Become a part of our caring community and help us put health first
The Quality Assurance, Clinical Professional 1 consults and collaborates with clinicians to ensure high accountability of compliance and quality. The Quality Assurance, Clinical Professional 1 work assignments are often straightforward and of moderate complexity.

The Quality Assurance, Clinical Professional 1 supports and implements programs to establish high quality standards in clinical products and services. Support, develop and operationalize methods to drive program and service consistency. Provide and support training and process management as needed. Requires applicable State licensure in field of study: Registered Nurse (RN), Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC) or other applicable professional license. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Use your skills to make an impact

CMS regulations, OASIS accuracy, and Medicare Conditions of Participation demand meticulous documentation.

A QA Auditor will help ensure all records meet federal, state, and payer-specific standards, reducing audit risk and financial exposure.

The QA Auditor will review Start of Care (SOC), Recertification, and Discharge documentation for completeness and accuracy, including coding, medication reconciliation, and plan of care alignment.

Timely QA review will reduce delays in billing and improve key performance indicators such as days to completion and turnaround time.

This role will support clinicians by identifying documentation gaps early, enabling faster corrections and submission.

As we transition to Kinnser EMR, the QA Auditor will ensure documentation workflows align with system capabilities and staff follow new protocols.

They will also monitor QA dashboard metrics and provide actionable feedback to improve staff performance.

The QA Auditor will identify trends in documentation errors and collaborate with leadership to develop targeted training and job aides.

This proactive approach supports continuous quality improvement and enhances patient safety.

Scheduled Weekly Hours

40

Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$53,700 - $72,600 per year

Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us
About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. OneHome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Requisition #: R-390499

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