The Quality Compliance Professional 2 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
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
Prefer Location: Kentucky and/or Central or 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 Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.
Scheduled Weekly Hours
40Pay 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.
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.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
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