Manager Quality Non-Calls - Bilingual English Spanish - Miami FL

Profile

Description

The Manager, Quality (Non-Calls) ensures that products meet certain standards of quality. The Manager, Quality (Non-Calls) works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The Manager, Quality (Non-Calls) is responsible for leading and guiding a team of auditors in delivering service and operational excellence through the consistent application of Humana Capital strategies which focus on continuous improvement in the areas of contributions, competencies and performance for the Grievance & Appeals Department. Manager, Quality (Non-Calls) is responsible for providing guidance, direct and coordinates quality assurance programs. As part of the scope, the training team and the Manager, Quality (Non-Calls) also works to improve the organization's efficiency and accuracy related to Medicare Part C/D Grievance and Appeals and to minimize compliance risk exposure to the company.

Required Qualifications:

Bachelor's Degree and/or equivalent of five(5) years work experience in healthcare.

Two (2) years of leadership experience.

Bilingual - English, Spanish - Must be able to speak, read and write in both languages without limitations or assistance.

Previous Grievances & Appeals experience.

Previous experience with participation in CMS audits.

Knowledge of Microsoft Office programs, intermediate to advance proficiency in Microsoft Access preferred.

Strong knowledge of Medicare standards and regulations.

Ability to work collaboratively with various departments, identifying and developing innovative processes.

Good organizational, Interpersonal and communication skills.

Must have a separate room with a locked door that can be used as a home office, to ensure you have absolute and continuous privacy while you work.

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

Additional Information

Work Location: Office based position but temporarily remote. The office is located in our Crossroads Building in Doral, FL

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include: Access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, Dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and well-being during the hiring process.

Direct Reports: Up to 4.

Work Days/Hours: Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST).

Training: 8 - 12 weeks

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Montage/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 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

Company info

Humana Inc.
Website : http://www.humana.com