Quality Compliance Professional
Humana
part-time
Posted on:
Location Type: Remote
Location: Florida • United States
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Salary
💰 $71,100 - $97,800 per year
About the role
- Participate in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences.
- Contribute to multidisciplinary committees, both external and internal, required by NCQA and the State Contract.
- Medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations in collaboration with internal and external stakeholders.
- Provider outreach to close care gaps.
- Completing and updating reports (including State Reports and Kentucky Medicaid Quality Improvement Committee reports).
Requirements
- 3+ years of previous experience working with member outreach on quality and performance improvement activities.
- 2+ years previous experience in healthcare quality improvement/quality operations.
- Knowledge of HEDIS/CMS/Quality.
- Experience with healthcare quality measures (example HEDIS, CAHPS).
- Comprehensive knowledge of Microsoft Office Word, PowerPoint, intermediate Excel experience (pivot tables/filtering, charts, formulas).
Benefits
- Paid time off
- 401(k) retirement savings plan
- Employee assistance program
- Business travel and accident
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
quality improvementperformance improvementmedical record auditshealthcare quality measuresHEDISCAHPSdata reportingExcel (pivot tables, filtering, charts, formulas)
Soft Skills
collaborationcommunicationinterpersonal skills