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Quality Improvement Professional

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Job Details
Job Order Number
JC163762675
Company Name
Humana
Physical Address

Chicago, IL 60684
Job Description

Description

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.

Responsibilities

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.

Required Qualifications

+ 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

Preferred Qualifications

+ 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

Additional Information

Scheduled Weekly Hours

40

About Us

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

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance.

Humana Safety and Security

Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request.

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