Become a part of our caring community and help us put health first
 The Quality Improvement Professional 1 partners and or aligns with Stars leadership to identify and set quality goals to maximize quality outcomes.
They must be comfortable functioning within a team setting especially as it relates to organizational guidelines, defined parameters, and meeting quality targets while on the other hand having some latitude to prioritize efforts, having the ability to work under minimal direction/independently.

The Quality Improvement Professional 1 will support clinicians and staff, working collaboratively with the Stars Clinical Quality RN/s, to support staffed clinical and operations teams including center administrators. Provide support, make recommendations and assist with implementing quality improvement best practice initiatives designed to improve Medicare quality measures (HEDIS), patient safety and patient experience (CAHPS-HOS). QIP assignment may be coverage of Conviva PCO staffed providers and or PCO Independent Network provider/practices functioning in a similar capacity as described previously for support to the staffed centers.

Best suited candidate will have an interest and practical experience working with clinical quality measures in particular medication adherence and HEDIS. Utilize approved avenues to outreach to patients with medication remindersMedical record review, retrieval, and submissions to health plans to support HEDIS gap closure.Distribute time-sensitive and actionable data to promote action on the part of clinical teams and operations to address opportunities and close gaps (excel moderate -to- advanced skills)Review and assess provider/member detail HEDIS data/gap reports to identify opportunities for improvement and gap closure. Using critical thinking skills, QIP 1 leads efforts to identify opportunities for improvement, workflow deficiencies and barriers. Provides support to provider/practice specific needs thus assisting in driving the effective implementation of the quality improvement strategy.Manage workloads, having the ability to meet time-sensitive deadlines such as the distribution of medication adherence reports to PCP.Train/educate teams on CMS Star measures, one-on-one or in a setting with multiple team members (clinicians, medical assistants, practice administrators, front office). The candidate must have excellent interpersonal skills as well as the ability to develop working relationships and partnerships. Must be a “people person” since the role requires seamless teamwork to achieve targets/meet goals. Present STARs performance information during meetings one-on-one or in wider settings. Create PowerPoint presentation.Collaborates with various stakeholders/partners (internal and external) including market operations/provider relations, coding teams; medical directors, clinical and health plan teams, and vendors to provide support and in some cases assist with the execution of workflows developed to improve outcomes for HEDIS, patient safety (such as medication adherence) and patient experience.Support quality initiatives eye screenings, bone mineral density, mobile mammogram etc.

Use your skills to make an impact
 

Required Qualifications:

·       Understanding of healthcare quality measures STARS (HEDIS, Patient Experience (CAHPS/HOS) and Patient Experience in particular knowledge of the measure technical specifications etc.

·       Minimum of 2 years' experience working with CMS STARs quality measures.

·       Prior experience in a fast-paced health care setting direct hands-on patient care, front office or provider relations field.

·       Experienced providing training 1:1 or in a group setting.

·       Ability to work independently but within team guidelines and standardized workflow.

·       Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint

·       Must be willing and able to travel locally to our Conviva Centers and live in Daytona, Florida. Mileage reimbursement will be provided.

Preferred Qualifications:

·       Bachelor’s or Associate Degree

·       Prior LPN/LVN, Lead Medical Assistant or Center Administrator experience.

·       Knowledge of Humana's internal policies, procedures, and systems.

Additional Information:

·       Work schedule: M-F, 8AM-5PM. Occasional after 5PM meeting.

·       Work-at-home and visits to various medical centers and or IPA offices.

·       Must reside in Daytona Florida

Alert:

Humana values personal identify 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.

Work At Home Statement:

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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 suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipAssociates 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 associates 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

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

 

$53,700 - $72,600 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 Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' 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.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.