Humana is a health insurance provider for individuals, families, and businesses. They are seeking a Quality Program Delivery Professional 2 to support quality program work across multiple states, collaborating with partners to drive quality measure improvement activities and analyze data trends.
Works collaboratively with members of the National Medicaid Quality team, state health plan quality teams, and external vendors to support quality measure improvement activities.
Investigates claims and medical records to identify opportunities for quality improvement and gap closure.
Analyzes trends in data and identify large scale opportunities for quality HEDIS measures improvement.
Prepares detailed reports and presentations on findings and recommended next steps.
Understand department and organizational strategy and operating objectives.
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
Qualification
Required
Bachelor's Degree.
One (1) year of healthcare NCQA HEDIS experience.
One (1) year of medical coding experience.
One (1) year of working in a health care environment/managed care setting.
Proficiency in Microsoft Office programs specifically PowerPoint, Word, and Excel.
Excellent communication skills, both oral and written.
This role requires significant attention to detail and analytical skills combined with an understanding of medical record and claims documentation requirements.
Preferred
Master's Degree.
Certified Professional in Healthcare Quality (CPHQ).
Experienced with presenting to various teams and leadership teams on all levels.
Strong analytical skills, including experience working with and analyzing data.
PMP or understanding of project management skills and techniques.
Benefits
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
Humana is a health insurance provider for individuals, families, and businesses.
