Quality Compliance Professional

Position Overview

• Location Type: [Not Specified]
• Job Type: Part-time
• Salary: [Not Specified]

Become a part of our caring community and help us put health first. This role is for a Quality Compliance Professional intern with Humana’s Kentucky Medicaid team. The intern will utilize Humana's training and mentorships, engaging formerly acquired skills to work on performance and quality improvement projects. This includes implementing member and provider targeted interventions to improve health outcomes and member and provider experiences.

Eligibility:

• Must confirm eligibility to participate in the Department of Defense SkillBridge Internship or Hiring our Heroes Military Spouse Fellowship.
  • DOD SkillBridge Internship Program: Provides an opportunity for transitioning military service members to gain civilian work experience with an employer for a period between 90 and 180 days upon approval.
  • Military Spouse Fellowship Program: Connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities.
• Networking opportunities will be provided while participating in the Internship or Fellowship.
• Due to factors such as location and/or requirements that cannot be modified, full-time employment is not guaranteed upon completion of the Internship or Fellowship.

Responsibilities

The Quality Compliance Professional 2 Intern will:

• Utilize Humana’s Kentucky Medicaid training and engage formerly acquired skills to participate in performance and quality improvement projects.
• Implement member and provider targeted interventions to improve health outcomes and member and provider experiences.
• Contribute to multidisciplinary committees, both external and internal, required by NCQA and the State Contract.
• Participate in, with potential to lead, Kentucky market quality improvement activities.
• Coordinate with the department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Specific activities include, but are not limited to:
  • Member outreach calls
  • Medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations in collaboration with internal and external stakeholders.
  • Provider outreach to close care gaps, audit records to identify improvement opportunities, and abstract data from records to close gaps.
  • Quality document updates (e.g., quality improvement program description, work plans, and evaluation).
  • Quality Improvement Committee meetings.
  • Completing and updating reports (including State Reports and Kentucky Medicaid Quality Improvement Committee reports).
  • Participating in multidisciplinary committees, both internal and external.

Requirements

Required Qualifications:

• Transitioning Service Member eligible to participate in SkillBridge or military spouse eligible to participate in the military spouse fellowship.
• 3+ years of previous experience working with member outreach on quality and performance improvement activities.
• 2+ years previous experience in healthcare quality improvement/quality operations.
• Knowledge of HEDIS/CMS/Quality.
• Experience with healthcare quality measures (e.g., HEDIS, CAHPS).
• Comprehensive knowledge of Microsoft Office Word, PowerPoint.
• Intermediate Excel experience (pivot tables/filtering, charts, formulas).
• Strong relationship building skills.
• Excellent written and oral communication skills.
• Ability to work independently under general supervision; must be self-directed and motivated.

Preferred Qualifications:

• Bachelor’s degree.
• Quality improvement experience with the Medicaid population.
• Certified Professional in Healthcare Quality (CPHQ).
• Previous quality or process improvement experience in a hospital or physician office practice.
• Ability to work independently under general instructions, self-directed.

Company Information

[Not Specified]