Responsibilities

The Quality Compliance Professional will utilize Humana’s Kentucky Medicaid training and engage formerly acquired skills to participate in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences. They will contribute to multidisciplinary committees, both external and internal, required by NCQA and the State Contract, participate in Kentucky market quality improvement activities, coordinate with the department, segment, and organizational strategy and operating objectives, including their linkages to related areas. This includes conducting member outreach calls, medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations, provider outreach to close care gaps, abstracting data from records to close gaps, quality document updates, and completing and updating reports. The role also involves participation in Quality Improvement Committee meetings and building strong relationships with internal and external stakeholders.