Humana · 1 day ago
Quality Improvement Professional
United States
Full-time
Remote
Mid Level
$65K/yr - $89K/yrHumana is committed to putting health first, and they are seeking a Quality Improvement Professional to play a vital role in auditing vendor agencies within the Pathways program. The role involves assessing vendor performance, ensuring compliance with quality standards, and improving service delivery to achieve positive outcomes for program participants.
Health CareHealth InsuranceInsuranceVenture Capital
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 support, guidance, and training to vendor agencies to enhance their compacity to deliver high quality service coordination
Analyze audit findings, tends 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 and/or in-person to establish goals and priorities. This involves evaluating 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, etc.)
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 closely with transition coordinators to support member choice
Coordinating with Care Coordinator on referrals for non-capitated services and capturing all services the member is receiving (regardless of payer), including their natural supports
Coordinating and consulting 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
Qualification
Required
Bachelor's degree or equivalent
Must reside in Indiana
Prior experience in a fast-paced insurance or health care setting
Experience in provider relations and education
Understanding of healthcare quality measures STARS, HEDIS, etc
Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
Proven analytical skills
Must be passionate about contributing to an organization focused on improving consumer experiences
Preferred
RN license
Knowledge of Humana's internal policies and systems
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
Founded in 1964
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Emilie Fritsch
Senior User Interface Design Engineer
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