Humana · 14 hours ago

Quality Compliance Professional 2

West Virginia, United States

Full-time

Remote

Mid Level

$70K/yr - $96K/yr

3+ years exp

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Responsibilities

Member outreach calls

Medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations in collaboration with internal and external stakeholders.

Provider outreach to close care gaps, audit records to identify improvement opportunities, and abstract data from records to close gaps

Quality document updates (example: quality improvement program description, work plans, and evaluation)

Quality Improvement Committee meetings

Completing and updating reports (including State Reports and Kentucky Medicaid Quality Improvement Committee reports)

Multidisciplinary committees, both internal and external

Strong relationship building skills

Excellent written and oral communication skills

Ability to work independently under general supervision, must be self-directed and motivated

Qualification

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Member outreachHealthcare quality improvementHEDIS knowledgeHealthcare quality measuresMicrosoft OfficeQuality improvement experienceCertified Professional in Healthcare QualityRelationship building