Quality Compliance Professional

Ohio, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Managed CareIndustries

Requirements

Candidates must reside in the EST or CST time zone and possess a Bachelor's degree or 3 years of related Quality Improvement work experience. A background in clinical managed care, knowledge of HEDIS/Quality Improvement, and comprehensive proficiency in Microsoft Office Suite are required. The ability to deliver clear and engaging presentations to diverse audiences is also necessary. Preferred qualifications include residing in Ohio, being detail-oriented, comfortable with tight deadlines, and possessing strong analytical, organizational, and prioritization skills.

Responsibilities

The Quality Compliance Professional supports Quality Improvement work for an Ohio Medicaid line of business, participating in internal and external projects. This role involves owning population streams, leading collaborative workgroups, developing and proposing initiatives, using data to drive progress, and initiating new strategies or projects. Responsibilities also include supporting or owning the development, review, and updating of Quality program documents and performing other assigned duties.

Skills

Quality Improvement

HEDIS

Clinical Managed Care

Microsoft Office Suite

Excel

Word

Presentation Skills

Data Analysis

Organizational Skills

Prioritization Skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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