Quality Improvement Professional at Humana in Indiana

Quality Improvement Professional Location: Remote Indiana Become a part of our caring community The Quality Improvement Professional plays an important role in auditing vendor agencies providing service coordination to member within the Pathways program. You will assess vendor performance, ensuring compliance with contractual obligations and quality standards, and improving service delivery. While the primary focus is on auditing vendor operations, you should also be prepared to provide support in service coordination activities. This ensures the delivery of high-quality services and positive outcomes for our program participants. The Service Coordinator (Quality Auditor) role involves conducting quality audits and may require onsite visits to vendor agencies throughout the state of Indiana. When supporting service coordination activities, your work will involve meeting members in their location to spend quality time assessing their needs and barriers and then connecting our member with quality services. Position Responsibilities: Conduct audits and evaluations of vendor agencies to assess compliance with contractual requirements, and quality standards. Provide input to improve the quality and effectiveness of service coordination provided by vendor agencies, including developing action plans based on audit findings and implementing process improvements. Provide guidance, and training to vendor agencies to enhance their compacity to deliver high-quality service coordination. Analyze audit findings, tend and performance metrics to identify areas for improvement. Administer ongoing long-term services and support (LTSS) related assessments through person-centered thinking approaches. Contacts members both telephonically or in-person to establish goals and priorities. You will evaluate resources, developing a plan of care, and identifying LTSS providers and community partnerships. The goal is to provide a combination of services and supports that best meet the needs and goals of the member and caregiver through person-centered thinking approaches. Development and modification of Service Plan and involve applicable members of the care team in care planning (Informal caregiver coach, PCP) Support members through navigation of their LTSS and related environmental and social needs Use available information about member to prevent the need for administration of duplicative assessments. Focus on supporting members or caregivers in accessing long-term services and support, social, housing, educational and other services, regardless of funding sources to meet their needs. Build trust and promote independence through a collaborative relationship with the Care Coordinator, member, and caregiver. Identify transition opportunities and work with transition coordinators to support member choice. Coordinate with Care Coordinator on referrals for non-capitated services and capturing all services the member is receiving (regardless of payer), including their natural supports. Coordinate and consult with Humana-contracted providers regarding delivery of LTSS services Participate in interdisciplinary Care team meetings (ICT) Connect and refer members to community resources and third-party payers Assist members in maintaining Medicaid eligibility Collaborate with Medical Director/Geriatrician/Care Coordinator as deemed necessary to ensure cohesive, holistic service delivery positive member outcomes. Use your skills to make an impact Required Qualifications Bachelor's degree or equivalent Must reside in Indiana Prior experience in a insurance or health care setting Experience in provider relations and education Understanding of healthcare quality measures STARS, HEDIS Must be passionate about contributing to an organization focused on improving consumer experiences Preferred Qualifications RN license Knowledge of Humana's internal policies and systems Additional Information Work at Home Guidance To ensure Home or Hybrid Home/Office associates', the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: We recommend at minimum a download speed of 25 Mbps and an upload speed of 10 Mbps; we suggest a wireless, wired cable or DSL connection. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Driver's License, Transportation, Insurance You will be a part of Humana's Driver Safety program and therefore requires and individual to have: Valid state driver's license Proof of personal vehicle liability insurance with at least $100,000/$300,000/$100,000 limits Access to a reliable vehicle Interview Format As part of our hiring process for this opportunity, we will use an exciting screening and interview technology called Modern Hire to enhance our hiring. We use this technology to gain valuable information from you of your relevant experience at a time that is best for your schedule. You will respond to the recruiters preferred response method by text, video, or voice technologies. You should anticipate this screen to take about 15 to 30 minutes. We will review your recorded screen, and then inform you if you will move forward to the next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $65,000 - $88,600 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.