Quality Compliance Professional

🔥 16 hours ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

💵 $71.1k - $97.8k / year

⏱ Part Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Participate in performance and quality improvement projects • Implement member- and provider-targeted interventions to improve health outcomes and experiences • Contribute to multidisciplinary committees required by NCQA and the State Contract • Participate in and potentially lead Kentucky market quality improvement activities • Conduct member outreach calls • Perform medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations • Conduct provider outreach to close care gaps • Audit records to identify improvement opportunities • Abstract data from records to close care gaps • Update quality documents, including quality improvement program descriptions, work plans, and evaluations • Attend Quality Improvement Committee meetings • Complete and update State Reports and Kentucky Medicaid Quality Improvement Committee reports • Travel quarterly to meetings in Louisville and attend provider visits as needed within Kentucky

🎯 Requirements

• 3+ years of previous experience working with member outreach on quality and performance improvement activities • 2+ years previous experience in healthcare quality improvement/quality operations • Knowledge of HEDIS/CMS/Quality • Experience with healthcare quality measures, including HEDIS and CAHPS • Comprehensive knowledge of Microsoft Office Word and PowerPoint • Intermediate Excel experience, including pivot tables/filtering, charts, and formulas • Must reside in the Eastern Time Zone • Ability to work independently under general supervision • Self-directed and motivated • Bachelor's degree preferred • Quality improvement experience with the Medicaid population preferred • Certified Professional in Healthcare Quality (CPHQ) preferred • Previous quality or process improvement experience in a hospital or physician office practice preferred

🏖️ Benefits

• Limited benefits effective upon hire • Paid time off • 401(k) retirement savings plan • Employee assistance program • Business travel and accident benefits • Remote work at home • Dedicated workspace and internet requirements to support remote work

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