Quality Compliance Professional

Choosegreaterpeoria; Montana; Remote; USD 71,000 - 98,000; Full time

Job summary

Humana Healthy Horizons seeks Quality Compliance Professionals to join their variable staffing pool. This role focuses on improving health outcomes through targeted interventions, member outreach, and compliance audits, ensuring high-quality healthcare services. Ideal candidates will have significant experience in healthcare quality improvement, excellent communication skills, and the ability to work independently.

Benefits

Paid time off

401(k) retirement savings plan

Employee assistance program

Qualifications

• 3+ years of experience with member outreach on quality improvement activities.
• 2+ years in healthcare quality improvement operations.
• Knowledge of HEDIS/CMS/Quality.

Responsibilities

• Participates in quality improvement projects by implementing interventions.
• Conducts medical record audits to evaluate compliance.
• Participates in internal and external committees.

Skills

Relationship building

Excellent written and oral communication

Self-directed and motivated

Education

Bachelor’s degree

Tools

Microsoft Office

Job description

Become a part of our caring community and help us put health first

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.

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 eastern standard time zone.

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

Work at Home Guidance 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.

Interview Format 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.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

0

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.$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 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. 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.