Quality Improvement Professional

About the role

Humana Illinois Market is seeking a Quality Improvement Professional to analyze and measure the effectiveness of existing business processes and develop sustainable, repeatable, and quantifiable business process improvements.

Responsibilities

• Research best business practices within and outside the organization to establish benchmark
• Collect and analyze process data to initiate, develop, and recommend business practices and procedures that focus on enhanced safety, increased productivity, and reduced cost
• Design, communicate, and implement an operational plan for completing a project
• Monitor progress and performance against the project plan to resolve problems and minimize delays
• Perform 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
• 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
• Support process improvement initiatives
• Supports Operations Managers in quality improvement initiatives
• Communicate audit findings to individuals and teams
• Participate in Interrater Reliability (IRR) meetings and assist in the development of Interpretation Standards to guide audit scoring and increase consistency across the Process Improvement Team
• Participate in root cause analysis research for audits

Requirements

• 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
• Prior project management experience
• 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
• Ability to work within highly structured contractual time compliance requirements with occasional short turnaround time

Preferred Qualifications

• 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
• Intermediate knowledge of Smartsheet
• Six Sigma or Project Management certification