Description

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Conviva, a wholly owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we’re seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry.
The Quality Improvement Coordinator implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Quality Improvement Coordinator performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The Quality Improvement Coordinator monitors quality investigations and compliance processes. Manages quality management system, department SharePoint, and department reporting. Audits processes as needed for compliance. Completes and submits reports to CMS and state regulators as required for clinical studies. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Job Functions:

• Conduct Medical Records Audit
• Reviewing Data for HEDIS Measures
• Review and update data from patients Health Plan
• Review Medical Records to determine if patient qualifies for exclusion
• Communicate all data to Centers and IPA's
• Patient outreach for Medication adherence
• Review Claims in portal
• Project Work and other duties as assigned

Required Qualifications:

• Prior experience in a fast-paced insurance or health care setting
• MUST be Bilingual in English and Spanish
• Prior experience in Quality Improvement / Clinical Setting
• Experience in provider relations and education
• Understanding of healthcare quality measures STARS, HEDIS, etc.
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
• Proven analytical skills
• Excellent communication skills, both oral and written
• Strong relationship building skills

Preferred Qualifications:

• Knowledge of Humana's internal policies, procedures and systems
• Knowledge of Medical Terminology
• Medical Assistant with quality and HEDIS measures experience

Additional Information:

This is a Remote Position -Working Hours: Monday to Friday 8:00 AM -5:00 PM

WAH Statement:

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

Alert:

Humana and its subsidiaries value personal identity protection. Please be aware that applicants being considered for an interview will 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.

Scheduled Weekly Hours

40