[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
Self-provided internet service meeting minimum speeds (25 Mbps download, 10 Mbps upload; wireless, wired cable or DSL suggested; satellite/cellular/microwave only if approved)
Ability to work from a dedicated space lacking ongoing interruptions to protect 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, identify root causes, and determine 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 InvestigationReportingAuditingCMS ReportingHealthcare RegulationsProgram Management

Questions & Answers

Common questions about this position

What is the work arrangement for this position?

The role supports Home or Hybrid Home/Office arrangements, with self-provided internet meeting minimum speeds of 25 Mbps download and 10 Mbps upload recommended.

What are the required qualifications for this role?

Required qualifications include prior experience in a fast-paced insurance or health care setting, experience in provider relations and education, understanding of healthcare quality measures like STARS and HEDIS, comprehensive knowledge of Microsoft Office (Word, Excel, PowerPoint), proven analytical skills, excellent communication skills, strong relationship building skills, and passion for improving consumer experiences.

What is the salary for the Quality Improvement Coordinator position?

This information is not specified in the job description.

What does the company culture emphasize?

The company emphasizes being a caring community that puts health first and focuses on continuously improving consumer experiences.

What makes a strong candidate for this role?

A strong candidate has prior experience in fast-paced healthcare or insurance settings, knowledge of quality measures like HEDIS and STARS, strong analytical and communication skills, and a preferred Bachelor's degree along with familiarity with Humana's systems.

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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