Become a part of our caring community and help us put health first
The Quality Improvement Coordinator participates in quality improvement (QI) activities for the South Carolina Humana Healthy Horizons Medicaid Market to comply with state requirements. This includes, but is not limited to, outbound calls to members to support various quality improvement activities/campaigns, medical record review and committee preparations.
The Quality Improvement Coordinator performs member and provider outreach calls, medical record audits and assists with QI project documentation. Decisions typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge. The Quality Improvement Coordinator performs advanced customer support/administrative/operational duties that require independent initiative and judgment. May apply intermediate mathematical skills.
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Required Qualifications
- Practicing LPN, LCSW license in the state of South Carolina
- 4+ years clinical/quality management or healthcare related experience.
- 2+ years' experience in a fast-paced insurance or health care setting reviewing HEDIS supplemental or hybrid data.
- Understanding of Medicaid healthcare quality measures such as HEDIS etc.
- Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
- Excellent communication skills, both oral and written
- Strong relationship building skills
- Must be passionate about contributing to an organization focused on continuously improving quality of care and consumer experiences
Preferred Qualifications
- Project Management, Lean Project experience
- Knowledge of Humana's internal policies, procedures, and systems
- Experience participating in and coordinating quality improvement projects and other quality improvement activities.
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 posed to make an impact on the future of healthcare, Humana has the right opportunity for you.
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.
$37,200 - $51,200 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
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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 because he or she is a protected veteran. 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.