Become a part of our caring community and help us put health first
The Senior Quality Compliance Professional works within the Quality Improvement Team. The Senior Quality Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Quality Compliance Professional uses quality compliance and improvement tools and methodology to assess, implement, and evaluate activities to monitor and continuously improve EPSDT and maternal health services and rates for Ohio Medicaid enrollees. The Senior Quality Compliance Professional has proven data analysis skills and a strong knowledge of EPSDT and maternal health requirements. The Senior Quality Compliance Professional is frequently required to interpret and analyze data to identify new creative interventions to increase EPSDT screening rates, improve access to pregnancy related services, independently determine an appropriate course of action, and present these ideas/plans to governance teams/committees. They assess educational needs of internal and external teams around EPSDT and maternal health services in order to develop and implement plans to increase knowledge.
The primary functions of this role include:
- Ensure member receipt of all EPSDT/HealthChek Services;
- Ensure member receipt of maternal health and postpartum care;
- Promote family planning services;
- Promote preventive health strategies;
- Identify and coordinate assistance for identified member needs specific to maternal/child health and EPSDT;
- Interface with community partners and pregnancy related services coordinators;
- Participate in EPSDT, maternal health and child quality performance improvement efforts; and
- Must reside in the state of Ohio and be available to travel for periodic meetings
Use your skills to make an impact
Required Qualifications
Must reside in the state of Ohio.
Senior Quality Compliance Professional must meet one of the following requirements:
- Unrestricted Registered Nurse in the State of Ohio OR
- Physician's Assistant OR
- Master's degree in health services, public health, or health care
- administration or another related field OR
- Certified Professional in Health Care Quality (CPHQ) OR
- Certified Health Care Quality Management (CHCQM)
Senior Quality Compliance Professional must meet all of the following:
- At least 3 years of experience in either delivering EPSDT services OR Health Care Quality Improvement
- Prior experience in a fast paced insurance or health care setting
- Knowledge of EPSDT and Child Health Services
- Knowledge of Maternal and Pregnancy related services
- Understanding of healthcare quality measures (example HEDIS)
- Comprehensive knowledge of Microsoft Office Outlook, One Note, Visio, Word and PowerPoint
- Strong relationship building skills
- Advanced Excel experience (pivot tables, charts, formulas)
- Excellent communication skills, both oral and written, ability to present to large groups
- 10% travel for meetings within the State of Ohio (see additional information)
- For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Additional Information
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.
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 required; 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.
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.
$78,400 - $107,800 per year
This 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 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.
