[Remote] Quality Improvement Coordinator at Humana

Indiana, United States

Apply Now

Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Prior experience in a fast-paced insurance or healthcare setting
Experience in provider relations and education
Understanding of healthcare quality measures (STARS, HEDIS, etc.)
Comprehensive knowledge of Microsoft Office (Word, Excel, PowerPoint)
Proven analytical skills
Excellent communication skills (oral and written)
Strong relationship-building skills
Passion for contributing to an organization focused on continuously improving consumer experiences
Minimum download speed of 25 Mbps and upload speed of 10 Mbps internet service
Dedicated workspace free from interruptions

Responsibilities

Implement quality improvement programs for all lines of business (annual program description, work plan, and annual evaluation)
Perform varied activities and moderately complex administrative/operational and customer support assignments
Monitor quality investigations and compliance processes
Manage quality management systems, department SharePoint, and department reporting
Audit processes as needed for compliance
Complete and submit reports to CMS and state regulators as required for clinical studies
Investigate state-reported incidents (background, causative factors, follow-up, and reporting to the state)
Coordinate interdepartmentally to investigate reported incidents to find root causes and resolutions
Follow standard policies/practices, allowing for some interpretation/deviation and/or independent discretion
Make decisions typically focused on the interpretation of area/department policy and methods for completing assignments

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.

Land your dream remote job 3x faster with AI

Try Jobo Free