Humana is seeking a Quality Improvement Coordinator to join the Wisconsin Medicaid Market (iCare) team. The Quality Improvement Coordinator supports quality improvement programs for all lines of business including annual program description, work plan and annual evaluation. Join this dedicated team and lead change in how health care for the underserved in Wisconsin is managed.

Responsibilities

• Monitors quality investigations and compliance processes.
• Contributes to the management of department SharePoint, electronic medical record system, and department reporting.
• Audits processes as needed for compliance.
• Pulls data for CMS, DHS, and MetaStar reporting as required.
• Provides department support for community partnerships.
• May participate in HEDIS projects as needed.

Required Qualifications

• Minimum one (1) year of experience in a health insurance or health care setting.
• Knowledge of healthcare quality measures, i.e., STARS, HEDIS, and Pay for Performance.
• Experience working in multiple systems at once and managing competing priorities.
• Proficiency in Microsoft Office Word, Excel, PowerPoint, SharePoint, Outlook, and Teams.
• Proven interpersonal skills working effectively with both internal and external partners.
• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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.
  • Associates 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 associates 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.

Preferred Qualifications

• Experience in provider relations and education.
• Proven analytical skills interpreting and utilizing data.
• Knowledge of NCQA accreditation requirements and guidelines.

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.
• Typical Work Days/Hours: 8:30 am - 5:00 pm CST
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes: 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more!

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Social Security Alert

Humana Values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

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This is a remote position

Scheduled Weekly Hours

40