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

Humana Healthy Horizons in Indiana is seeking a Senior Quality Improvement Professional who will implement quality improvement programs and support the Quality Assurance and Performance Improvement Program for Indiana Pathways Program/Humana Medicaid including annual program description, work plan, annual evaluation, and the management, tracking, and reporting of Performance Improvement Projects. The work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Position Responsibilities:

• Monitors quality compliance processes.
• Participates in interdepartmental projects and activities.
• Develops and implements performance improvement projects and oversees PIP's related day-to-day activities.
• Acts as lead liaison with internal stakeholders and business partners in the collection of data and intervention information or delegates this responsibility to team members as needed.
• Monitors and audits processes as needed for compliance.
• Ensures that CMS protocols for PIPs are followed and that all steps outlined in the CMS protocols for performance improvement projects are documented.
• Monitors and tracks measures and develops internal strategies for improvement.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components.
• Performs duties with minimal direction.
• Exercises considerable latitude in determining objectives and approaches to assignments.

Use your skills to make an impact
 

Required Qualifications

• Five (5)+ years of work experience in a health insurance or health care setting.
• Experience working with healthcare quality measures, i.e. HEDIS/STARS/CMS/Operational Quality.
• Proficient in Microsoft Office Word, Excel and PowerPoint.

Preferred Qualifications

• Bachelor’s degree.
• Experience with Long Term Care programs or related populations.
• Registered Nurse, Licensed Practical Nurse (LPN), or Master’s/Bachelor’s in social work.
• Strong business skills, including sales and marketing objectives.
• Excellent communication skills, both oral and written.
• Strong relationship-building skills.

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: Indiana resident preferred.
• Typical Work Days/Hours: Monday – Friday, 8:00 am – 5:00 pm EST.

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

HireVue

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.

Nationwide Remote - This is a remote nationwide position.

According to the Indiana Office of Inspector General Rule, 42 IAC 1-5-14 Post-Employment Restrictions, if you are a cu