Humana Senior Quality Compliance Professional in Chicago, Illinois

Description

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.

Responsibilities

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:

  • Coordinates/prepares quarterly/annual reports in coordination with CMS and State contractual obligations

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

Special Projects:

  • 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

Required Qualifications

  • 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.

Desired Qualifications

  • 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

Additional Information

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

40

About Us

Equal Opportunity Employer

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