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

Humana is seeking a Quality Improvement Professional to join the Wisconsin Medicaid Market team. The Quality Improvement Professional monitors incident investigations and compliance processes; manages the incident management system and processes, department SharePoint, and department reporting; audits processes as needed for compliance; completes and submits reports to state regulators as required.

• Implement quality improvement initiatives related to incident management.
• Manage the Incident Management System (IMS) that connects to the state reporting system.
• Review, triage, and process incident reports, quality alerts, and program integrity events applying critical thinking skills to ensure sufficient detail and appropriate follow up and regulatory compliance.
• Act as a resource to Care Management by providing guidance and education around incident investigation and follow up.
• Collaborate with Quality Management Leadership and other Departments to ensure appropriate and timely response to immediate member risk or concerns.
• Assist with the collection, organization, and evaluation of data from incidents, events, quality alerts, and statements of deficiency as a means to identify and address systemic quality concerns.
• Ensure opportunities for stakeholder involvement in activities aimed at supporting quality through the monitoring of incidents and events.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree or more advanced degree in the human services area (Social work, Sociology, Psychology or Nursing) and a minimum of one year experience working with elders, adults with physical disabilities or adults with intellectual disabilities OR bachelor’s degree or more advanced degree in any area other than human services with a minimum of 3 years’ experience working with elders, adults with physical disabilities or adults with intellectual disabilities.
• 3 years’ experience in a health insurance, health care, or long-term services and support setting.
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint.

Preferred Qualifications

• Experience in WI long-term care programs, Family Care or Family Care Partnership, providing care management support to elders and/or adults with physical or intellectual disabilities.
• Experience in data collection, analysis, and reporting.

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.  
• Work Location: must reside in Wisconsin.
• Travel: minimal travel within Wisconsin may be required.  
• Typical Work days/hours: Monday – Friday, 8:00 am – 5:00 pm Central Standard Time (CST)

WAH Internet 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 recommended; 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.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities