[Remote] Quality Improvement Professional at Humana

Michigan, United States

Apply Now

Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Bachelor's degree
Prior experience in a fast-paced insurance or health care setting
2+ years’ 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
Must reside and perform work in the State of Michigan
May travel to the Market office for meetings and/or training; may occasionally meet with Members or providers on an ad hoc basis

Responsibilities

Implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation
Supports quality improvement programs for all lines of business by gathering and analyzing data related to critical incidents including report generation and submission as required
Monitors quality investigations and compliance processes
Partners with external entities in the market, Internal and Enterprise departments
May manage quality management system, department SharePoint, and department reporting
Audits processes as needed for compliance

Skills

HEDIS

STARS

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

data analysis

quality improvement

provider relations

healthcare quality measures

analytical skills

communication 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