Remote Quality Improvement Specialist - Critical Incidents

Humana; Columbia (SC); On-site; USD 65,000 - 89,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Illinois Market is seeking a Process Improvement Professional who analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable improvements. You will work under oversight of Critical Incidents and align with organizational objectives to drive quality and compliance.

Join a remote role with flexible hours and opportunities to influence statewide audits and reporting, while collaborating with Care Coordinators, Leadership, and Quality teams to

Qualifications

• Bachelor’s degree is required.
• 2 years of experience related to process improvement, compliance measures, or auditing practices or 2 years of experience in Medicaid/Medicare Care Coordination.
• Experience in Care Coaching and/or Care Coordination.
• Proven oral / written communication and presentation skills.
• Excellent analytical skills, able to manipulate and interpret data.

Responsibilities

• Collaborate with the Care Coordinators to determine strategies to mitigate risk to the member.
• Monitor Care Coordination activity and documentation regarding the Critical Incident.
• Collaborate with Leadership staff regarding closure of Critical Incidents.
• Provide oversight for quarterly State audits of Critical incidents.
• Provide reporting to the Illinois Quality Improvement Committee on Critical Incidents and support the Annual Quality report.
• Prepare monthly reports to the State regarding Critical Incidents.
• Provide training for new hires and current staff on updates to CIs.
• Perform audits focused on improving compliance and quality.
• Review new Critical Incident entries for appropriateness to be classified as a Critical Incident according to guidelines.
• Development and review of internal quality metrics.
• Support process improvement initiatives. Assist in reviewing new Job Aids to support Learning Design and Learning Facilitation staff.
• Review current Job Aids and Policies and Procedures as requested.
• Create and present education as requested by the Process Improvement Manager.
• Participates in root cause analysis research for audits.
• Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and guidance.

Skills

Oral/written communication

Analytical thinking

Care Coordination

Education

Bachelor’s degree

Job description

Humana Illinois Market is seeking a Process Improvement Professional who analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable improvements. You will work under oversight of Critical Incidents and align with organizational objectives to drive quality and compliance.

Join a remote role with flexible hours and opportunities to influence statewide audits and reporting, while collaborating with Care Coordinators, Leadership, and Quality teams to