at Humana in Springfield, Illinois, United States
Job Description
Become a part of our caring community and help us put health first
Humana is seeking a Quality Improvement Professional to join the Wisconsin Medicaid Market team. The Quality Improvement (QI) Professional performs duties to support optimized performance on quality indicators and initiatives across all lines of business. The QI professional fosters a culture of quality improvement in collaboration with appropriate teams that directly impact members by ensuring data accuracy in reporting, investigation, auditing, compliance, and improvement opportunities.
+ Assist in the collection, organization, and evaluation of Quality Assessment Performance Improvement (QAPI) program data from multiple sources for all lines of business to support the quality management program and assist in the development of annual quality program documents (program description, workplan, and evaluation).
+ Use continuous quality improvement process through tracking and trending data including clinical analysis and reporting for quality monitoring and improvement.
+ Collaborate with Quality Management Leadership and other departments to ensure risks are mitigated and concerns are addressed related to quality management activities and findings.
+ Participate in quality improvement activities that span multiple lines of business.
+ Audit processes as needed for compliance.
+ Complete and submit reports to CMS, state regulators, and enterprise.
+ Understand department, market, lines of business, and organizational strategy and operating objectives.
+ Lead or participate in initiatives to further quality related organizational objectives.
+ Organize and lead Market NCQA related activities in collaboration with other Departments and enterprise partners.
Use your skills to make an impact
Required Qualifications
+ Bachelor’s degree.
+ 3 years of experience in a health insurance, health care setting or long-term services or supports program.
+ Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.
+ Experience in data collection, analysis, and reporting.
+ Experience in leading quality or healthcare related initiatives from inception to completion.
Preferred Qualifications
+ Knowledge of NCQA accreditation process and standards.
+ 3 years of experience in any of the following WI Medicaid Programs: Family Care, Family Care Partnership, BadgerCare Plus, SSI managed care.
+ 3 years of experience in quality management.
Additional Information
+ Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
+ Travel: minimal travel to WI may be required for in person meetings.
+ Typical Work days/hours: Monday – Friday, 8:00 am – 5:00 pm Central Standard Time (CST)
WAH Internet Requirements
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.
Benefits
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Health benefits effective day 1
+ Paid time off, holidays, volunteer time and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Parental and caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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.
Nationwide Remote – This is a remote nationwide position.
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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.$63,400 – $87,400 per yearThis 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 because he or she is a protected veteran. 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
