Quality Compliance Professional

Humana

1d•Remote

About The Position

Humana Healthy Horizons is seeking Quality Compliance Professionals (VSP) who participate in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences. These positions are part of the variable staffing pool (VSP). Variable Staffing Pool Humana associates work part to full time hours based on business need. VSPs are not eligible for associate bonuses and receive limited benefits, which are effective upon hire. The hours for this role are generally aligned based on the associate and business task at hand. Job Description The Quality Compliance Professional 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. Use your skills to make an impact

Requirements

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).

Nice To Haves

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.

Responsibilities

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.