Quality Programs Delivery Professional 2

Employment Type: Full-time

Position Overview

Humana Healthy Horizons is seeking a Quality Programs Delivery Professional 2 to support quality program work across multiple states. This role involves collaborating with internal and external partners to complete fast-paced, time-sensitive projects. The position requires interpretation and independent determination of appropriate courses of action for varied work assignments.

Responsibilities

• Collaborates with members of the National Medicaid Quality team, state health plan quality teams, and external vendors to support quality measure improvement activities.
• Investigates claims and medical records to identify opportunities for quality improvement and gap closure.
• Analyzes trends in data to identify large-scale opportunities for quality HEDIS measures improvement.
• Prepares detailed reports and presentations on findings and recommended next steps.
• Understands department and organizational strategy and operating objectives.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, requiring minimal direction and receiving guidance where needed.

Requirements

• Bachelor's Degree.
• One (1) year of healthcare NCQA HEDIS experience.
• One (1) year of medical coding experience.
• One (1) year of working in a healthcare environment/managed care setting.
• Proficiency in Microsoft Office programs (PowerPoint, Word, and Excel).
• Excellent communication skills, both oral and written.
• Significant attention to detail and analytical skills.
• Understanding of medical record and claims documentation requirements.

Preferred Qualifications

• Master's Degree.
• Certified Professional in Healthcare Quality (CPHQ).
• Experience presenting to various teams and leadership at all levels.
• Strong analytical skills, including experience working with and analyzing data.
• PMP certification or understanding of project management skills and techniques.

Workstyle and Additional Information

• Location Type: Remote
• Workdays and Hours: Monday – Friday; 8:00 am – 5:00 pm Eastern Standard Time (EST).
• Travel: Up to 5% for onsite team engagement meetings, potentially outside your state of residence.
• Internet Service Requirements:
  • Minimum download speed of 25 Mbps and upload speed of 10 Mbps.
  • Wireless, wired cable, or DSL connection suggested.
  • Satellite, cellular, and microwave connections are permissible only with leadership approval.
  • California, Illinois, Montana, or South Dakota residents will receive a bi-weekly internet expense payment.
• Work Environment: Must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Equipment: Humana will provide appropriate telephone equipment.
• Interview Format: HireVue technology will be used for the interview process.

Company Information

Become a part of our caring community and help us put health first.