Quality Improvement Professional

Become a part of our caring community Humana Illinois Market is seeking a Quality Improvement Professional who analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable business process improvements. The Quality Improvement Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. In this role, the professional must understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

• Research best business practices within and outside the organization to establish benchmark Data.
• 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.
• Use your skills to make an impact.

• Bachelor's degree 2 years of experience related to process improvement, compliance measures, or auditing practices or 2 years of experience in Medicaid/Medicare Care Coordination Ability to travel to Schaumburg office at minimum 2- 4 times yearly for State and CMS Mock audits Occasional travel to Louisville for an extended period during CMS Audits Excellent analytical skills, able to manipulate and interpret data.
  
  Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint. Ability to work within highly structured contractual time compliance requirements with occasional short turnaround time.

• Reside in the state of Illinois.
• Knowledge of HEDIS/Stars/CMS/Quality.
• Experience in Medicaid or Medicare Guidelines.
• Detail orientated and comfortable working with tight deadlines in a fast-paced environment.

Workstyle:
Remote Travel:
Travel may be required to support state and federal audits. Core Workdays &

Hours:

Monday – Friday; typically, 8:00am – 5:00pm Central Standard Time. Work at Home Requirements:
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana…