Senior Quality Compliance Professional

🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $78.4k - $107.8k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ 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

• ensure member receipt of all EPSDT/HealthChek Services • ensure member receipt of maternal health and postpartum care • promote family planning services • promote preventive health strategies • identify and coordinate assistance for identified member needs specific to maternal/child health and EPSDT • interface with community partners and pregnancy related services coordinators • participate in EPSDT, maternal health and child quality performance improvement efforts

🎯 Requirements

• Must reside in the state of Ohio • Unrestricted Registered Nurse in the State of Ohio OR Physician's Assistant OR Master's degree in health services, public health, or health care administration or another related field OR Certified Professional in Health Care Quality (CPHQ) OR Certified Health Care Quality Management (CHCQM) • At least 3 years of experience in either delivering EPSDT services OR Health Care Quality Improvement • Prior experience in a fast paced insurance or health care setting • Knowledge of EPSDT and Child Health Services • Knowledge of Maternal and Pregnancy related services • Understanding of healthcare quality measures (example HEDIS) • Advanced Excel experience (pivot tables, charts, formulas)

🏖️ 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