Quality Improvement Professional 2

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Become a part of our caring community

Humana Illinois Market seeks a Quality Improvement Professional 2 to analyze and measure current business processes and develop sustainable, repeatable improvements. This role involves varied work assignments requiring interpretation and. The professional must understand departmental, segment, and organizational strategies and goals, as well as their connections to related areas, to drive effective process enhancements.

Position Responsibilities:

You will research and benchmark best practices to drive quality and operational excellence, while analyzing process data to identify opportunities to improve safety and cost effectiveness. You will conduct CMS and state audits, including HRA compliance and transitions of care, to strengthen compliance and quality outcomes. You will also validate source system data for required reporting, present audit cases, and support the organization through CMS and state audit activities.

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
* Manipulate and interpret data
* Work within structured contractual time compliance requirements with occasional short turnaround time.
Preferred Qualifications:
* Knowledge of HEDIS/Stars/CMS/Quality.
* Experience in Medicaid or Medicare Guidelines.

Work at Home Requirements
* 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.
* Humana will provide Home or Hybrid Home/Office associates 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.

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.
* Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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.

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 RangeThe 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 year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of BenefitsHumana, 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

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