Quality Improvement Professional

Quality Improvement Professional

Become a part of our caring community and help us put health first. Humana Gold Plus Integrated is seeking a Quality Improvement Professional to implement quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Quality Improvement Professional performs quality investigations to implement and support quality improvement initiatives for the Illinois Long Term Service Support (LTSS) Program and serves on the Process Improvement Team reporting directly to the Process Improvement Lead. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Position Responsibilities :

• Research best business practices within and outside the organization to establish benchmark data.
• Collect and analyze process data to initiate, develop, and recommend business practices and procedures that focus on enhanced safety, increased productivity, and reduced cost.
• Performs 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 as needed.
• Collaborate with Managers, Senior Care Coordinators and Care Coordination staff for remediations identified on audits.
• Assist in special projects as needed.
• Development and review of internal quality metrics.
• Support process improvement initiatives.
• Assist in reviewing new Job Aids to support the team of Learning Design and Learning Facilitation staff.
• Review current Job Aids and Policies and Procedures as requested.
• Create and present education as requested by the Process Improvement Lead.
• Supports Operations Managers in quality improvement initiatives.
• Assist Managers in communicating audit findings to individuals and teams.
• Participates in Interrater Reliability (IRR) meetings and assists in the development of Interpretation Standards to guide audit scoring and increase consistency across the Process Improvement Team.
• Participates in root cause analysis research for audits.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Required Qualifications :

Preferred Qualifications :

Additional Information :

Scheduled Weekly Hours 40

Pay Range $71,500 - $97,500 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 designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us Humana Inc. (NYSE : HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https : / / www.humana.com / legal / accessibility-resources?source=Humana_Website.