[Remote] Quality Improvement Coordinator at Humana

Indiana, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Prior experience in a fast paced insurance or health care 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, both oral and written
Strong relationship building skills
Passionate about contributing to an organization focused on continuously improving consumer experiences
(Preferred) Bachelor Degree
(Preferred) Knowledge of Humana's internal policies, procedures and systems
Ability to work from home with self-provided internet meeting minimum speeds (25 Mbps download, 10 Mbps upload recommended; wireless, wired cable or DSL suggested; satellite/cellular/microwave only if approved)
Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information

Responsibilities

Implement quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation
Perform varied activities and moderately complex administrative/operational/customer support assignments
Monitor quality investigations and compliance processes
Manage quality management system, 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 including background, causative factors, follow up, and reporting to state
Coordinate inter-departmentally to investigate reported incidents to find root causes and resolutions
Follow standard policies/practices with some opportunity for interpretation/deviation and independent discretion
Work within defined parameters to identify work expectations and quality standards, with latitude over prioritization/timing under minimal direction

Skills

Key technologies and capabilities for this role

Quality ImprovementComplianceSharePointRoot Cause AnalysisIncident InvestigationCMS ReportingHealthcare RegulationsQuality Management SystemsAuditingProgram Evaluation

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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