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

Humana Healthy Horizons is seeking a Quality Programs Delivery Professional 2 who will support quality program work in multiple states. They will collaborate with internal and external partners to complete fast paced and time sensitive projects. The Quality Program Delivery Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• Works collaboratively 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 and identify large scale opportunities for quality HEDIS measures improvement.
• Prepares detailed reports and presentations on findings and recommended next steps.
• Understand department and organizational strategy and operating objectives.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Use your skills to make an impact
 

Required Qualifications

• 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 health care environment/managed care setting.
• Proficiency in Microsoft Office programs specifically PowerPoint, Word, and Excel.
• Excellent communication skills, both oral and written.
• This role requires significant attention to detail and analytical skills combined with an understanding of medical record and claims documentation requirements.

Preferred Qualifications

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

Additional Information

• Workstyle: This is remote a position.
• Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Travel: Up to 5 % to onsite team engagement meetings possibly outside your state of residence.

WAH Internet Statement

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.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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 at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$71,100 - $97,800 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are design