Quality Improvement Professional

Become a part of our caring community
Humana Illinois Market is seeking a Quality Improvement Professional who analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable business process improvements. The Quality Improvement Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. In this role, the professional must understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Position Responsibilities:

• Research best business practices within and outside the organization to establish benchmark Data.
• Performs CMS and State audits focused on improving compliance and quality.
• Focus audits – may include annual and initial HRA compliance, Critical Incident audits, post discharge and transition of care contacts.
• Provide Source System Validations for Universe and State reports
• Prepare cases, present cases and/or provide navigation responsibilities for CMS audits and State audits
• Participate and present in reports for Quality Improvement Committee and other committees as needed
• Collaborate with Managers, Senior Care Coordinators and Care Coordination staff for remediations identified on audits
• Assist in special projects as needed
• Development and review of internal quality metrics.
• Support process improvement initiatives.
  • Assist in reviewing new Job Aids to support the team of Learning Design and Learning Facilitation staff.
  • Review current Job Aids and Policies and Procedures as requested.
  • Create and present education as requested by the Process Improvement Lead.
• Supports Operations Managers in quality improvement initiatives.
  • Assist Managers in communicating audit findings to individuals and teams.
  • Participates in Interrater Reliability (IRR) meetings and assists in the development of Interpretation Standards to guide audit scoring and increase consistency across the Process Improvement Team.

• Participates in root cause analysis research for audits.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Use your skills to make an impact

Required Qualifications:

• Bachelor's degree
• 2 years of experience related to process improvement, compliance measures, or auditing practices or 2 years of experience in Medicaid/Medicare Care Coordination
• Ability to travel to Schaumburg office at minimum 2- 4 times yearly for State and CMS Mock audits
• Occasional travel to Louisville for an extended period during CMS Audits
• Excellent analytical skills, able to manipulate and interpret data.
• Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.
• Ability to work within highly structured contractual time compliance requirements with occasional short turnaround time.

Preferred Qualifications:

• Reside in the state of Illinois
• Knowledge of HEDIS/Stars/CMS/Quality.
• Experience in Medicaid or Medicare Guidelines.
• Detail orientated and comfortable working with tight deadlines in a fast-paced environment

Additional Information:

• Workstyle: Remote
• Travel: Travel may be required to support state and federal audits.
• Core Workdays & Hours: Monday – Friday; typically, 8:00am – 5:00pm Central Standard Time.

Work at Home 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.$65,000 - $88,600 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.