Quality Compliance Professional - Humana
Concord, NH
About the Job
Become a part of our caring community and help us put health first
Humana Healthy Horizons in Kentucky is seeking a Quality Compliance Professional 2 who will participate in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences. This role contributes to multidisciplinary committees, both external and internal, required by NCQA and the State Contract.
The Quality Compliance Professional 2 participates in, with potential to lead, Kentucky market quality improvement activities, and understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. This includes but is not limited to:
+ Member outreach calls.
+ Medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations in collaboration with internal and external stakeholders.
+ Provider outreach to close care gaps, audit records to identify improvement opportunities, and abstract data from records to close gaps.
+ Quality document updates (example: quality improvement program description, work plans, and evaluation).
+ Quality Improvement Committee meetings.
+ Completing and updating reports (including State Reports and Kentucky Medicaid Quality Improvement Committee reports).
+ Multidisciplinary committees, both internal and external.
Qualified candidates will possess:
+ Strong relationship building skills.
+ Excellent written and oral communication skills.
+ Ability to work independently under general supervision, must be self-directed and motivated.
+ Critical thinking skills.
Use your skills to make an impact
Required Qualifications
+ Bachelor's degree or equivalent work experience (4 years of work experience in a health care setting).
+ 2+ years of experience working with member/patient outreach on quality and performance improvement activities.
+ 2+ years of experience in healthcare quality improvement/quality operations.
+ Experience with healthcare quality measures (HEDIS, CAHPS, etc.).
+ Comprehensive knowledge of Microsoft Office Word, PowerPoint, intermediate Excel experience (pivot tables/filtering, charts, formulas).
Preferred Qualifications
+ Licensed RN, LPN or Licensed Clinical Social Worker in the state of Kentucky.
+ Bachelor's degree in business, health care or a related field.
+ Certified Professional in Healthcare Quality (CPHQ).
+ Quality improvement experience with the Medicaid population.
Additional Information:
+ Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
+ Travel: Twice/year to Kentucky for team meetings.
+ Typical Work Days/Hours: must be available Monday - Friday, 8:00 am - 4:30 pm EST.
WAH Internet Requirements
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Benefits
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Health benefits effective day 1
+ Paid time off, holidays, volunteer time and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Parental and caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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.$69,800 - $96,200 per yearThis 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
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Humana Healthy Horizons in Kentucky is seeking a Quality Compliance Professional 2 who will participate in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences. This role contributes to multidisciplinary committees, both external and internal, required by NCQA and the State Contract.
The Quality Compliance Professional 2 participates in, with potential to lead, Kentucky market quality improvement activities, and understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. This includes but is not limited to:
+ Member outreach calls.
+ Medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations in collaboration with internal and external stakeholders.
+ Provider outreach to close care gaps, audit records to identify improvement opportunities, and abstract data from records to close gaps.
+ Quality document updates (example: quality improvement program description, work plans, and evaluation).
+ Quality Improvement Committee meetings.
+ Completing and updating reports (including State Reports and Kentucky Medicaid Quality Improvement Committee reports).
+ Multidisciplinary committees, both internal and external.
Qualified candidates will possess:
+ Strong relationship building skills.
+ Excellent written and oral communication skills.
+ Ability to work independently under general supervision, must be self-directed and motivated.
+ Critical thinking skills.
Use your skills to make an impact
Required Qualifications
+ Bachelor's degree or equivalent work experience (4 years of work experience in a health care setting).
+ 2+ years of experience working with member/patient outreach on quality and performance improvement activities.
+ 2+ years of experience in healthcare quality improvement/quality operations.
+ Experience with healthcare quality measures (HEDIS, CAHPS, etc.).
+ Comprehensive knowledge of Microsoft Office Word, PowerPoint, intermediate Excel experience (pivot tables/filtering, charts, formulas).
Preferred Qualifications
+ Licensed RN, LPN or Licensed Clinical Social Worker in the state of Kentucky.
+ Bachelor's degree in business, health care or a related field.
+ Certified Professional in Healthcare Quality (CPHQ).
+ Quality improvement experience with the Medicaid population.
Additional Information:
+ Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
+ Travel: Twice/year to Kentucky for team meetings.
+ Typical Work Days/Hours: must be available Monday - Friday, 8:00 am - 4:30 pm EST.
WAH Internet Requirements
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Benefits
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Health benefits effective day 1
+ Paid time off, holidays, volunteer time and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Parental and caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
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.$69,800 - $96,200 per yearThis 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
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana