Humana

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 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.

Quality Compliance Professional

ComplianceCompliancePart TimeRemoteTeam 10,001+Since 1961H1B SponsorCompany SiteLinkedIn

Location

Kentucky

Posted

18 days ago

Salary

$71.1K - $97.8K / year

Bachelor Degree5 yrs expEnglish

Job Description

• participates in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences. • contributes to multidisciplinary committees, both external and internal, required by NCQA and the State Contract. • 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).

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

Benefits

  • paid time off
  • 401(k) retirement savings plan
  • employee assistance program
  • business travel and accident

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