Humana

Quality Compliance Professional

Ohio, United States

Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, Managed CareIndustries

Quality Compliance Professional 2

Employment Type: Full-time

Location Type: Remote Work at Home

Salary: $71,100 - $97,800 per year (eligible for bonus incentive plan)


Position Overview

Become a part of our caring community and help us put health first. The Quality Compliance Professional 2 supports Quality Improvement work for an Ohio Medicaid line of business. This work includes participation in projects internal and external to the organization.

This role requires minimal direction and receives guidance where needed, following established guidelines/procedures. The Quality Compliance Professional 2 makes decisions regarding their own work methods, occasionally in ambiguous situations.


Responsibilities

  • Own population streams.
  • Participate in and lead collaborative workgroups.
  • Develop and propose initiatives.
  • Use data to move work forward.
  • Initiate and drive new strategies or projects.
  • Support or own the development, review, and updating of Quality program documents.
  • Take on other duties as assigned.

Requirements

  • Must reside in EST or CST time zone.
  • Bachelor’s degree or 3 years related Quality Improvement work.
  • Knowledge of HEDIS/Quality Improvement.
  • Clinical Managed Care background.
  • Comprehensive knowledge of Microsoft Office Suite (i.e., Excel, Word, etc.).
  • Able to deliver clear and engaging presentations to diverse audiences.

Preferred Qualifications

  • Reside in the state of Ohio.
  • Detail-oriented and comfortable working with tight deadlines in a fast-paced environment.
  • Ability to work independently under general instructions; self-directed and motivated.
  • Strong oral/written communication and presentation skills.
  • Strong analytical skills, able to manipulate and interpret data.
  • Organizational and prioritization skills.

Workstyle & Schedule

  • Workstyle: Remote Work at Home
  • Schedule/Hours: Monday through Friday, 40-hour work week schedule. Core hours are between 7:00 AM - 6:00 PM Eastern.
  • Overtime: Anticipate occasional overtime or weekends as business needs require.
  • Travel: 5% (Occasional travel to Humana's offices for training or meetings may be required).

Additional Information

  • Interviewing Technology: HireVue will be used as part of the hiring process.
  • Internet Requirements (for remote work):
    • Minimum download speed of 25 Mbps and upload speed of 10 Mbps.
    • Wired cable or DSL connection is suggested.
    • Satellite, cellular, and microwave connections may be used only if approved by leadership.
    • California, Illinois, Montana, or South Dakota residents will be provided a bi-weekly internet expense payment.
  • Equipment: Humana will provide appropriate telephone equipment.
  • Work Environment: Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Benefits

Humana, Inc. and its affiliated subsidiaries offer 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.

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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