Quality Compliance Professional

Humana; Ohio; Remote; USD 30,000 - 45,000; Full time

Job summary

Humana is seeking a Quality Compliance Professional Intern to join their Kentucky Medicaid team. This remote internship offers military service members and spouses the chance to engage in performance and quality improvement projects while benefiting from training and mentorship. Responsibilities include member outreach, compliance audits, and participation in multidisciplinary committees. Ideal candidates should possess strong communication skills and experience in quality improvement.

Benefits

Networking opportunities

Remote work adaptability

Qualifications

• Transitioning Service Member eligible for SkillBridge or Military Spouse Fellowship.
• 3+ years in member outreach for quality improvement activities.
• Comprehensive knowledge of MS Office (Word, PowerPoint, Excel).

Responsibilities

• Implement member and provider interventions to improve health outcomes.
• Conduct medical record audits to assess provider compliance.
• Participate in quality improvement activities.

Skills

Member outreach

Quality improvement

Relationship building

Written communication

Oral communication

Self-motivation

Education

Bachelor’s degree

Tools

Microsoft Office

Job description

Join to apply for the Quality Compliance Professional role at Humana

Get AI-powered advice on this job and more exclusive features.

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

Job Summary

Are you a transitioning military service member or a Military Spouse looking for an internship that supports the goal to put health first?

The Quality Compliance Professional intern will utilize Humana's training and mentorships and engage formerly acquired skills to work with Humana’s Kentucky Medicaid team by participating in performance and quality improvement projects including implementing member and provider targeted interventions to improve health outcomes and member and provider experiences. If you are interested in this position, you will be required to confirm eligibility to participate in the Department of Defense SkillBridge Internship or Hiring our Heroes Military Spouse Fellowship.

The DOD SkillBridge Internship Program provides an opportunity for transitioning military service members to gain civilian work experience with an employer for a period between 90 and 180 days upon approval.

The Military Spouse Fellowship Program connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities.

• Networking opportunities will be provided while participating in the Internship or Fellowship.
• Due to factors such as location, and/or requirements that cannot be modified, full-time employment is not guaranteed upon completion of the Internship or Fellowship.

Role Responsibilities

The Quality Compliance Professional 2 Intern will utilize Humana’s Kentucky Medicaid training and engage formerly acquired skills to 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 Intern participates in, with potential to lead, Kentucky market quality improvement activities, coordinate with the 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)
• Participation in 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

Required Qualifications

Use your skills to make an impact

• Transitioning Service Member eligible to participate in SkillBridge or military spouse eligible to participate in the military spouse fellowship
• 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

The DOD SkillBridge Internship Program provides an opportunity for transitioning military service members to gain civilian work experience with an employer for a period between 90 and 180 days upon approval.

The Military Spouse Fellowship Program connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities.

• Networking opportunities will be provided while participating in the Internship or Fellowship.
• Due to factors such as location, and/or requirements that cannot be modified, full-time employment is not guaranteed upon completion of the Internship or Fellowship.

Additional Information

Workstyle: Remote Work at Home

Location: Kentucky Preferred / Must reside in Eastern Time Zone

Schedule: 8:00 AM - 4:30 PM Eastern

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.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [e-mail] with instructions on how to add the information into your official application on Humana’s secure website.

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

Scheduled Weekly Hours

0

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.