Description
Humana Healthy Horizons is seeking Quality Compliance Professionals (VSP) who participate in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences.
The Quality Compliance Professional participates in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences. This role contributes to multidisciplinary committees, both external and internal, required by NCQA and the State Contract.
Responsibilities:
- Conduct member outreach calls
- Perform medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations
- Participate in provider outreach to close care gaps, audit records to identify improvement opportunities, and abstract data from records to close gaps
- Update quality documents, such as quality improvement program descriptions, work plans, and evaluations
- Participate in Quality Improvement Committee meetings
- Complete and update reports, including State Reports and Kentucky Medicaid Quality Improvement Committee reports
- Participate in multidisciplinary committees, both internal and external
- Develop strong relationships with internal and external stakeholders
- Communicate effectively in writing and orally
- Work independently under general supervision, being self-directed and motivated
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 (e.g., HEDIS, CAHPS)
- Comprehensive knowledge of Microsoft Office Word, PowerPoint, and intermediate Excel experience (pivot tables/filtering, charts, formulas)
Preferred Qualifications:
- Bachelor's degree
- Quality improvement experience with the Medicaid population
- Certified Professional in Healthcare Quality (CPHQ)
- Previous quality or process improvement experience in a hospital or physician office practice
Additional Information:
- Workstyle: Remote, work at home
- Location: Kentucky Preferred / Must reside in Eastern Time Zone
- Schedule: 8:00 AM - 4:30 PM EST, Monday - Friday
- Travel: Quarterly meeting attendance in Louisville and Provider visits as needed within Kentucky if located within reasonable commute
- Pay Range: $71,100 - $97,800 per year