[Remote] Senior Quality Improvement Professional at Humana

Louisiana, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Must meet one of the following requirements: Certified Professional in Health Care Quality (CPHQ), Certified Health Care Quality Management (CHCQM), or comparable education and experience in data and outcomes measurement – equivalent to 4 years of experience
Bachelor’s Degree or 4 or more years of equivalent experience
Prior experience in a fast-paced insurance or health care setting
Understanding of healthcare quality measures STARS, HEDIS, etc
Comprehensive knowledge of Microsoft product suite
Proven analytical skills
Available to report to the Market office for occasional meetings

Responsibilities

Implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation
Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors
Monitors quality investigations and compliance processes
Manages quality management system, department SharePoint, and department reporting
Audits processes as needed for compliance
Completes and submits reports to CMS and state regulators as required for clinical studies
Begins to influence department’s strategy
Makes decisions on moderately complex to complex issues regarding technical approach for project components

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.

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