Job Information
CenterWell Quality Improvement Professional in Remote, North Carolina
Become a part of our caring community and help us put health first
The Quality Improvement Professional provides support to employed physicians and their teams, collaborate with, make best practice recommendations and develop practice specific strategies designed to improve Medicare quality measures (HEDIS) as well as Part D/Patient Safety and Patient Experience (CAHPS-HOS).
The Quality Improvement Professional implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation.
The Quality Improvement Professional work assignments are often of moderate complexity. The position will entail professional level assessments and prioritizations but will also require the QIP to function within a team setting to achieve targets/goals.
The Quality Improvement Professional functions effectively within a team setting, when applicable works independently to make decisions that will positively impact improved outcomes for CMS Stars quality measure (HEDIS, patient safety and patient satisfaction).
Provide support at all levels for workflows targeting improvement in outcomes for Star measures by identifying opportunities, make best practice recommendations, and support as necessary and applicable for center specific needs thus assisting in driving the effective implementation of the quality improvement strategy. The position involves hands on support and assistance to clinical and operations teams.
Develop, enhance, and maintain relationships with various partners both internal (market operations and clinical leaders, clinicians and support teams) and external (payors) to support collaborations and partnerships.
Maintain knowledge of CMS Stars quality measure specifications as well as updates to the measures (HEDIS/Part D/CAHPS-HOS).
Understand department, segment, and organizational strategy and operating objectives, including linkages to related areas. Makes decisions regarding own work methods and prioritizations with minimal direction, receives guidance and input from established and approved workflow and leaders as needed. Follows established guidelines/procedures.
Review and assess provider/member detail HEDIS data (care gap reports) to identify opportunities for gap closure. Assist with distribution of this data as well as time sensitive patient safety data (typically medication adherence) to promote action on the part of clinical teams and operations teams at staffed medical centers to address opportunities.
Medical record/chart review. Review medical records, retrieve and submit to payors as applicable. In the process identify opportunities for improvement, post review share findings and make best practice recommendations, such as CPT ll code submission, member/patient-reported documentation opportunities etc.
The role supports information management structures through knowledge of existing software to assist in the collection and analysis of data for performance patterns, trends and opportunities for improvement.
Use your skills to make an impact
Required Qualifications
2- 5 years working with CMS Stars/Quality measures. This position requires extensive knowledge and understanding of each measure specifications and categories.
Experienced professional, past or current experience supporting physician groups to promote performance and outcomes.
Ability to articulate measure requirements to clinical and operational teams.
Have experience and be comfortable training 1:1 and or large groups.
Proven analytical skills to assess Stars performance, identify opportunities and work with teams to positively impact performance and outcomes.
Excellent communication skills, both oral and written
Strong relationship and team building skills.
Passionate about contributing to an organization focused on continuously improving patient/consumer experiences.
Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
Preferred Qualifications
Bachelor's degree
Prior Lead Medical Assistant, Center Administrator, LVN or RN experience.
Knowledge of Humana's internal policies, procedures, and systems.
Additional Information
Alert
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.
Interview Process: HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$52,500 - $72,300 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.
About us
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources