Quality Improvement Professional
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Chicago, IL 60684
The Quality Improvement Professional 2 implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Quality Improvement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Quality Improvement Professional 2 monitors quality investigations and compliance processes for Long Term Services and Supports (LTSS). Humana LTSS program offers person-centered care planning, service coordination and self-supported care services for members receiving long-term care (LTC) and home and community (HCBS) services. The Quality Improvement Professional 2 is responsible for performing programmatic evaluation to ensure contractual adherence and that LTSS Care/Case Manager/Coordinators are being adherent to policy and procedures.
This position supports quality management system, department reporting, and audit processes as needed for contractual compliance. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
+ Bachelor’s degree
+ Prior experience in health care industry/setting and/or case management
+ Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
+ Excellent communication skills, both oral and written
+ Strong relationship building skills
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
+ Strong process orientation, troubleshooting and conflict resolution with a firm commitment to quality.
+ Ability to work within highly structured contractual time compliance requirements with occasional short turnaround time
+ Knowledge of Humana’s internal policies, procedures and systems
+ Registered Nurse with active license in the respective state or license in the state of their residence if the state is participating the Nurse License Compact Law;
+ CCM, CPHQ, CMCN or equivalent certification
+ Master level Social Worker with active license in the respective state/commonwealth, (e.g., LCSW, LMSW, LAPSW, etc.)
+ Master’s Degree in related field (MBA, MPH, MNA, etc)
+ Experience providing care coordination to persons receiving long-term care and/or home and community based services and/or work experience in managed and/or long-term care settings working with Medicaid and/or Medicaid/Medicare eligible populations
+ Prior experience with healthcare quality measures STARS, HEDIS, etc. and/or clinical program monitoring/evaluation
Scheduled Weekly Hours
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms -when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
Equal Opportunity Employer
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