- Execute day-to-day quality activities supporting patient support program processes, case management documentation, and call documentation - Perform quality reviews of evaluated calls, documentation, and service outputs to ensure compliance with sponsor-approved procedures and work instructions - Provide real-time quality guidance and issue identification to support consistent and compliant program execution - Participate in client audits as needed. - Participate in the maintenance and execution of the Quality Management System (QMS) for the patient support program - Author, review, and update quality-related SOPs, work instructions, monitoring tools, and quality plans - Ensure documentation meets pharmaceutical sponsor, regulatory, and inspection-readiness standards - Support compliance with applicable laws and regulations, including HIPAA, state privacy requirements, and FDA post-marketing expectations - Participate in inspection readiness activities through document preparation, procedure review, and quality risk assessments - Partner with Compliance and Legal teams to evaluate quality and compliance risks related to patient services - Provide quality oversight for adverse event (AE), product complaint (PC), and special situation intake and documentation - Ensure safety-related data is accurately captured, documented, and escalated in accordance with sponsor and SOP requirements - Support pharmacovigilance activities through quality trending, issue escalation, and procedural enhancements - Assist with safety-related inquiries, quality investigations, and inspection or sponsor requests - Identify quality issues, deviations, and trends through ongoing review and data analysis - Perform root cause analysis and support development and tracking of corrective and preventive actions (CAPAs) for the QA related CAPA’s - Recommend and implement process improvements to strengthen compliance, quality, and patient experience - Partner with Training teams to develop and maintain quality-focused onboarding and continuing education materials - Work with the Special Projects QAU team on improving the training program and content. - Provide direct feedback and coaching recommendations based on quality findings to QA Specialists, QA Team Leads and QA Supervisors - Support remediation efforts related to quality or documentation gaps - Serve as a quality subject matter expert for patient support program processes - Collaborate across functions to ensure changes are assessed for quality impact and implemented compliantly - Support new program launches from a quality perspective. - Assist with the development of Program Criteria and the review and approval process with operations and the client.

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. Medica’s Quality Specialists play a key role in delivering consistent service excellence to members across all Contact Center interactions. This is achieved by recognizing and reinforcing exemplary service through quality evaluations. Quality Specialists identify individual and department-wide trends, as well as training and educational opportunities, through quality evaluations and Helpline call reviews. The Quality Specialist maintains accurate and up-to-date department reference materials to Contact Center staff, assisting them in resolving calls on the first contact. This role also involves utilizing the call recording system to evaluate calls and ensuring scoring consistency through regular calibration with the Quality team and the departments they support. Performs other duties as assigned. Required Qualifications - High school diploma or an equivalent combination of education and work experience - 2+ years of related work experience Preferred Qualifications - Experience working with Government and/or Commercial lines of business - Excellent written and verbal communication skills - Strong computer proficiency, with the ability to use multiple systems and software applications - Problem-solving and analytical skills to support timely and thorough issue resolution - Highly organized, with the ability to manage multiple priorities simultaneously This position is a Remote role. To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI. The full salary grade for this position is $37,600 - $64,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $37,600 - $56,385. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees. The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law. Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Become a part of our caring community The Quality Improvement Professional plays an important role in auditing vendor agencies providing service coordination to member within the Pathways program. You will assess vendor performance, ensuring compliance with contractual obligations and quality standards, and improving service delivery. While the primary focus is on auditing vendor operations, you should also be prepared to provide support in service coordination activities. This ensures the delivery of high-quality services and positive outcomes for our program participants. The Service Coordinator (Quality Auditor) role involves conducting quality audits and may require onsite visits to vendor agencies throughout the state of Indiana. When supporting service coordination activities, your work will involve meeting members in their location to spend quality time assessing their needs and barriers and then connecting our member with quality services. Position Responsibilities: - Conduct audits and evaluations of vendor agencies to assess compliance with contractual requirements, and quality standards. - Provide input to improve the quality and effectiveness of service coordination provided by vendor agencies, including developing action plans based on audit findings and implementing process improvements. - Provide guidance, and training to vendor agencies to enhance their compacity to deliver high-quality service coordination. - Analyze audit findings, tend and performance metrics to identify areas for improvement. - Administer ongoing long-term services and support (LTSS) related assessments through person-centered thinking approaches. - Contacts members both telephonically or in-person to establish goals and priorities. You will evaluate resources, developing a plan of care, and identifying LTSS providers and community partnerships. The goal is to provide a combination of services and supports that best meet the needs and goals of the member and caregiver through person-centered thinking approaches. - Development and modification of Service Plan and involve applicable members of the care team in care planning (Informal caregiver coach, PCP) - Support members through navigation of their LTSS and related environmental and social needs Use available information about member to prevent the need for administration of duplicative assessments. - Focus on supporting members or caregivers in accessing long-term services and support, social, housing, educational and other services, regardless of funding sources to meet their needs. - Build trust and promote independence through a collaborative relationship with the Care Coordinator, member, and caregiver. - Identify transition opportunities and work with transition coordinators to support member choice. - Coordinate with Care Coordinator on referrals for non-capitated services and capturing all services the member is receiving (regardless of payer), including their natural supports. - Coordinate and consult with Humana-contracted providers regarding delivery of LTSS services - Participate in interdisciplinary Care team meetings (ICT) - Connect and refer members to community resources and third-party payers - Assist members in maintaining Medicaid eligibility - Collaborate with Medical Director/Geriatrician/Care Coordinator as deemed necessary to ensure cohesive, holistic service delivery positive member outcomes. Use your skills to make an impact Required Qualifications - Bachelor's degree or equivalent - Must reside in Indiana - Prior experience in a insurance or health care setting - Experience in provider relations and education - Understanding of healthcare quality measures STARS, HEDIS - Must be passionate about contributing to an organization focused on improving consumer experiences Preferred Qualifications - RN license - Knowledge of Humana's internal policies and systems Additional Information Work at Home Guidance To ensure Home or Hybrid Home/Office associates', the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: - We recommend at minimum a download speed of 25 Mbps and an upload speed of 10 Mbps; we suggest a wireless, wired cable or DSL connection. - Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Driver's License, Transportation, Insurance You will be a part of Humana's Driver Safety program and therefore requires and individual to have: - Valid state driver's license - Proof of personal vehicle liability insurance with at least $100,000/$300,000/$100,000 limits - Access to a reliable vehicle Interview Format As part of our hiring process for this opportunity, we will use an exciting screening and interview technology called Modern Hire to enhance our hiring. We use this technology to gain valuable information from you of your relevant experience at a time that is best for your schedule. You will respond to the recruiters preferred response method by text, video, or voice technologies. You should anticipate this screen to take about 15 to 30 minutes. We will review your recorded screen, and then inform you if you will move forward to the next round of interviews. 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 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. $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, “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 Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ 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.

• Manage and control test suites in ALM Octane, ensuring that all tests are executed according to established standards. • Create and execute manual and automated tests for Mobile applications developed with Angular and Ionic. • Perform integration and functional testing of RESTful APIs, ensuring the quality of system integrations. • Apply and promote the use of the test pyramid, performing root cause analysis and defect management for continuous improvement. • Collaborate on code versioning using Git, ensuring that changes do not negatively impact software stability. • Use Agile methodologies for project and task management, actively participating in Scrum and Kanban ceremonies. • Promote the use of Generative Artificial Intelligence within the team to help solve complex problems. • Propose improvements to testing processes and application architecture in collaboration with development teams. • Document and report bugs, track them through to resolution, and suggest improvements to the testing workflow. • Contribute to regression and performance testing.