Senior Clinical Risk Evaluation Professional
Humana
full-time
Posted on:
Location Type: Remote
Location: Remote • California, Illinois, Montana, South Dakota • 🇺🇸 United States
Visit company websiteSalary
💰 $86,300 - $118,700 per year
Job Level
Senior
About the role
- supporting the development, implementation and monitoring of medical/financial risk and healthcare fraud
- queries robust data pipelines, performs statistical analyses, and translates findings into clear reports and dashboards for internal partners and leadership
- analyze data through a clinical evidence-based lens to uncover insights and effectively communicate a meaningful narrative that supports informed decision-making
- provide clinical advice and perspectives on outliers and fraud analysis to associates throughout the department
- recommend plans for departmental efficiencies, initiates and coordinates cross-departmental collaborations, and conducts clinical training sessions across teams
Requirements
- Bachelor's degree
- Licensed Practical Nurse (LPN) or Licensed Registered Nurse (RN) without restriction in applicable state
- Minimum 5 years of experience with Humana or other healthcare claims systems
- Ability to do extensive research on a given topic
- Microsoft Excel skills (including sorting/filtering data and utilizing pivot tables)
- Proven ability to pull and analyze large data sets and effectively communicate a meaningful narrative with those findings
- Proven ability to perform clinical reviews and review medical records
- Ability to collaborate and create connections with outside Clinical areas
- Excellent presentation and communication skills, both oral and written
- Strong relationship building skills
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Benefits
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data analysisstatistical analysisclinical reviewsmedical record reviewdata queryingdata visualizationreportingrisk assessmentfraud analysisclinical training
Soft skills
communication skillspresentation skillsrelationship buildingcollaborationresearch skillsnarrative communicationorganizational skillsleadershipproblem-solvingefficiency improvement
Certifications
Licensed Practical Nurse (LPN)Licensed Registered Nurse (RN)