Quality Improvement Professional (Virginia Medicaid)

Humana Inc; Virginia (MN); Remote; USD 65,000 - 89,000; Full time

Job summary

Join Humana's Healthy Horizons team as a Quality Improvement Professional 2 to enhance health initiatives through member outreach and project management. In this role, you will coordinate activities for quality metrics and compliance, engaging with internal and external partners to bridge care gaps. With a focus on quality improvement and member communication, this remote position allows for impactful contributions in a supportive environment.

Benefits

Competitive benefits including medical, dental, and vision

401(k) retirement savings plan

Paid time off and holidays

Qualifications

• Two years of experience in health plan quality management.
• One year of experience working with HEDIS measures.
• Proficiency in Microsoft Word, Excel, and PowerPoint.

Responsibilities

• Performs outreach calls for quality improvement projects.
• Monitors quality metrics and compliance processes.
• Assists with managing quality improvement initiatives.

Skills

Communication

Relationship-building

Analytical skills

Education

Associate degree

Bachelor’s degree in health or social science

Tools

Microsoft Office

Job description

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

Humana Healthy Horizons in Virginia is seeking a Quality Improvement Professional 2 who will provide outreach for interventions and initiatives providing support and coordination of activities, participation in state workgroups as need and collaboration with internal and external partners for Community events with focus on gaps in care.

• Performs Member outreach calls, assists with quality improvement project documentation, and supports various quality improvement activities.
• Monitors quality metrics and compliance processes.
• Assists with managing quality improvement projects and activities related to Healthcare Effectiveness Data and Information Set (HEDIS) and Non-HEDIS quality improvement initiatives.
• Audits processes as needed for compliance.
• Exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques.
• Performs advanced customer support, administrative, and operational duties that require independent initiative and judgment.

Use your skills to make an impact

Required Qualifications

• Must reside and preform work in the Commonwealth of Virginia.
• Associate degree.
• Two (2) years of experience in health plan quality management.
• One (1) or more years of experience working directly with Healthcare Effectiveness Data and Information Set (HEDIS) measures and quality improvement initiatives measures.
• Experience participating in and/or coordinating quality improvement projects and other quality improvement activities.
• Proficiency in Microsoft Office applications specifically Word, Excel, and PowerPoint.
• Excellent communication skills, both oral and written.
• Strong relationship-building skills.

Preferred Qualifications

• Bachelor’s degree in a health or a social science field.
• Proven analytical skills such as the ability to filter or pivot large volumes of data to identify target populations from a large data set.

Additional Information

• Workstyle: This is a remote position with minimal travel.
• Travel: Up to 25% to Humana Healthy Horizons office in Glen Allen, VA as needed for business needs.
• Typical Workdays/Hours: Monday – Friday; 8:00am -5:00pm, Eastern Standard Time (EST).

Work from Home Internet Statement

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.
• 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

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.$65,000 - $88,600 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 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.