Quality Improvement Professional

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About the role

Become a part of our caring community   Join our growing Illinois Market team as a Quality Improvement Professional! Reporting to the Manager of Process Improvement, you will help guide quality, compliance, and continuous improvement initiatives across the organization. You will partner with operational teams, support audits and regulatory reviews, analyze performance trends, and help turn insights into meaningful actions that enhance outcomes for our members and the business. Position Responsibilities: • Research best business practices within and outside the organization to establish benchmark Data. • Perform CMS and State audits focused on improving compliance and quality. • Focus audits – may include annual and initial HRA compliance, Critical Incident audits, post discharge and transition of care contacts. • Provide Source System Validations for Universe and State reports • Prepare cases, present cases and/or provide navigation responsibilities for CMS audits and State audits • Participate and present in reports for Quality Improvement Committee and other committees • Collaborate with Managers, Senior Care Coordinators and Care Coordination staff for remediations identified on audits • Support special projects • Develop internal quality metrics. • Support process improvement projects • Help review new Job Aids to support the team of Learning Design and Learning Facilitation staff. • Review current Job Aids and Policies and Procedures. • Create and present education as requested by the Process Improvement Lead. • Support Operations Managers in quality improvement initiatives. • Assist Managers in communicating audit findings to individuals and teams. • Participate in Interrater Reliability (IRR) meetings and help develop Interpretation Standards to guide audit scoring and increase consistency across the Process Improvement Team. • Participate in root cause analysis research for audits. Use your skills to make an impact   Required Qualifications: • Bachelor's degree • 2 years of experience related to process improvement, compliance measures, or auditing practices OR 2 years of experience in Medicaid/Medicare Care Coordination • 1 year of experience presenting information, training materials, or business updates to individuals or groups • 1 year of experience in Excel with the ability to manipulate and interpret data Preferred Qualifications: • Reside within the State of Illinois • Knowledge of HEDIS/Stars/CMS/Quality. • 1 year of Medicaid or Medicare experience Additional Information: • Workstyle: Remote- Work from home • Travel: Minimal travel- visit Schaumburg office at minimum 2- 4 times yearly for State and CMS Mock audits and occasional trip to our Louisville office • Core Workdays & Hours : Monday – Friday; typically, 8:00am – 5:00pm Central Standard Time. Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.   Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment

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