[Remote] Quality Improvement Professional at Humana

Michigan, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Bachelor's Degree
2 years of experience in quality management and/or quality improvement
Strong understanding of HEDIS and other national quality measures
Knowledge of Microsoft Office programs (Word, Excel, PowerPoint)
Strong collaboration and communication skills
Excellent analytical and presentation skills
Strong organizational skills
Must reside in MI or within 40 miles of the border in Indiana or Ohio

Responsibilities

Implement quality improvement programs for Michigan Medicaid, including annual program description, work plan, and annual evaluation
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
Understand department, segment, and organizational strategy and operating objectives
Make decisions regarding own work methods, occasionally in ambiguous situations
Follow established guidelines/procedures
Use skills to make an impact
Additional responsibilities based on business need

Skills

Quality Management

Quality Improvement

HEDIS

Data Analysis

Communication

Presentation

Organization

Microsoft Office Suite

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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