The Senior Quality Compliance Professional completes annual quality reviews and research. The Senior Quality Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Quality Compliance Professional will implement, maintain, coordinate, lead and monitor reports on contractually required committees in market while building relationships with committee members. In this role you will:
Compliance to Accreditation, State and Federal Regulations:
Implements/maintains committees in accordance with State and CMS contractual obligations
Implements/maintains committee meetings
Identifies members and locations
Sets-up and coordinates meetings
Develops and maintains key program documents including team charter(s) and policies and procedures
Implements/maintains partnership with key leaders vested in care of members and their caregivers where applicable
Works with internal communication teams to develop strategy to communicate committee participation.
Facilitation and Committee Oversight:
Coordinates/leads committee meetings to obtain committee members’ viewpoints using principles of qualitative research.
Plans topics and questions for discussion based on business strategy and contractual obligations
Skillfully and respectfully conducts meetings
Builds a trusting, caring, and supportive environment for group discussion
Reports and Analysis:
Leadership/Community Interactions: Interacts with market leaders, other departments, and community where applicable to promote Humana programs and strategic initiatives
Communicates effectively to a broad span of internal and external customers
Presents as needed to internal and external clients
Participates in work groups/lean projects/task forces which may include but are not limited to analysis and improvement activities, community outreach and partnerships
Please note this role will require 20% travel locally with limited out of state travel
Health Care-related Bachelor's degree and/or equivalent work experience
4 years or more of health plan or healthcare experience
Prior experience in working in a fast paced health plan or healthcare setting
Comprehensive knowledge of Microsoft Word, Excel and PowerPoint
Strong relationship building skills
Excellent communication skills, both oral and written
Strong relationship building skills
This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
Quality Improvement experience
HEDIS knowledge and/or experience
Prior experience in working with quality metrics in a fast paced insurance or health care setting
Experience working with healthcare providers
Knowledge of Humana's internal policies, procedures and systems
Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Scheduled Weekly Hours
Equal Opportunity Employer
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