Quality Improvement Professional 2

Humana • Work at Home - Illinois, IL

1d • Remote

About The Position

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. Some experience in project management is also desired. In this role, the professional must understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Requirements

• 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
• Prior project management experience.
• 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.
• Ability to work within highly structured contractual time compliance requirements with occasional short turnaround time.
• 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• 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.
• Intermediate knowledge of Smartsheet.
• Six Sigma or Project Management certification.

Responsibilities

• Research best business practices within and outside the organization to establish benchmark data.
• Collect and analyze process data to initiate, develop, and recommend business practices and procedures that focus on enhanced safety, increased productivity, and reduced cost.
• Design, communicate, and implement an operational plan for completing a project.
• Monitor progress and performance against the project plan to resolve problems and minimize delays.
• Perform 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.

Benefits

• 401k
• Medical
• Dental
• Vision
• Variety of supplemental insurances
• Tuition assistance
• Telephone equipment appropriate to meet the business requirements for their position/job
• Competitive pay
• Bonus incentive plan
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level