Quality Compliance Professional

Become a part of our caring community

Job Description Summary

Humana Healthy Horizons is seeking Quality Compliance Professionals (VSP) who participate in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences.

These positions are part of the variable staffing pool (VSP). Variable Staffing Pool Humana associates work part to full time hours based on business need. VSPs are not eligible for associate bonuses and receive limited benefits, which are effective upon hire. The hours for this role are generally aligned based on the associate and business task at hand.

Job Description

The Quality Compliance Professional participates 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.
• Strong relationship building skills.
• Excellent written and oral communication skills.
• Ability to work independently under general supervision, must be self-directed and motivated.

Use your skills to make an impact

Required Qualifications

• 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 (example HEDIS, CAHPS).
• Comprehensive knowledge of Microsoft Office Word, PowerPoint, intermediate Excel experience (pivot tables/filtering, charts, formulas).

Preferred Qualifications

• Bachelor's degree.
• Quality improvement experience with the Medicaid population.
• Certified Professional in Healthcare Quality (CPHQ).
• Previous quality or process improvement experience in a hospital or physician office practice.
• Ability to work independently under general instructions, self-directed and motivated.

Additional Information

Workstyle: Remote, work at home.

Location: Kentucky Preferred / Must reside in Eastern Time Zone.

Schedule: 8:00 AM - 4:30 PM EST, Monday - Friday.

Travel: Quarterly meeting attendance in Louisville and Provider visits as needed within Kentucky if located within reasonable commute.

Work at Home 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 required; wireless, wired cable or DSL connection is suggested. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Scheduled Weekly Hours: 1

Pay Range: $71,100 - $97,800 per year.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident.

About us

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.

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.