Quality Reviewer - Clinical Advisor

Job Description: Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly traded health benefits companies, with approximately 9 million medical members. 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.

Over its 45-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.


The Humana Kentucky Quality Management department is looking for a self-motivated detail-oriented RN who functions well as a team player. This person will work closely with Humana providers to develop collaborative relationships and will be based in the Humana Lexington office.

Assignment summary:
- Initiates quality reviews and facilitates the QI process
- Attends and participates in the quality improvement committee meetings
- Visits provider offices to promote education and quality improvement activities
- Coordinates and manages clinical studies, performs audits, and develops clinical interventions

Key Accountabilities:
- Ability to manage several projects effectively.
- Good presentation and communication skills both verbal and written.
- Ability to work collaboratively and independently
- Demonstrate some experience with Microsoft Word, Excel, PowerPoint, and the Internet.
- Requirements:
- Registered Nurse (active Kentucky license)
- 3-5 years clinical experience
- Previous UM, QM, Compliance, and/ or Medicare experience desired
- Ability to travel in Kentucky and some overnight stay

For information contact: Bshermansanders@

Searchable Keywords: Quality Reviewer - Clinical Advisor / gj-mo

Expected Travel Time: About 50%