Become a part of our caring community and help us put health first

The Quality Improvement Professional plays an important role in auditing vendor agencies providing service coordination to member within the Pathways program. You will assess vendor performance, ensuring compliance with contractual obligations and quality standards, and improving service delivery. While the primary focus is on auditing vendor operations, you should also be prepared to provide support in service coordination activities. This ensures the delivery of high-quality services and positive outcomes for our program participants. The Service Coordinator (Quality Auditor) role involves conducting quality audits and may require onsite visits to vendor agencies throughout the state of Indiana. When supporting service coordination activities, your work will involve meeting members in their location to spend quality time assessing their needs and barriers and then connecting our member with quality services.

Position Responsibilities:

Conduct audits and evaluations of vendor agencies to assess compliance with contractual requirements, and quality standards.
Provide input to improve the quality and effectiveness of service coordination provided by vendor agencies, including developing action plans based on audit findings and implementing process improvements.
Provide support, guidance, and training to vendor agencies to enhance their compacity to deliver high quality service coordination.
Analyze audit findings, tends and performance metrics to identify areas for improvement.
Administer ongoing long-term services and support (LTSS) related assessments through person-centered thinking approaches.
Contacts members both telephonically and/or in-person to establish goals and priorities. This involves evaluating resources, developing a plan of care, and identifying LTSS providers and community partnerships. The goal is to provide a combination of services and supports that best meet the needs and goals of the member and caregiver through person-centered thinking approaches.
Development and modification of Service Plan and involve applicable members of the care team in care planning (Informal caregiver coach, PCP, etc.)
Support members through navigation of their LTSS and related environmental and social needs Use available information about member to prevent the need for administration of duplicative assessments.
Focus on supporting members or caregivers in accessing long-term services and support, social, housing, educational and other services, regardless of funding sources to meet their needs.
Build trust and promote independence through a collaborative relationship with the Care Coordinator, member, and caregiver.
Identify transition opportunities and work closely with transition coordinators to support member choice.
Coordinating with Care Coordinator on referrals for non-capitated services and capturing all services the member is receiving (regardless of payer), including their natural supports.
Coordinating and consulting with Humana-contracted providers regarding delivery of LTSS services
Participate in interdisciplinary Care team meetings (ICT)
Connect and refer members to community resources and third-party payers
Assist members in maintaining Medicaid eligibility
Collaborate with Medical Director/Geriatrician/Care Coordinator as deemed necessary to ensure cohesive, holistic service delivery positive member outcomes.

Use your skills to make an impact

Required Qualifications

Bachelor's degree or equivalent
Must reside in Indiana
Prior experience in a fast-paced insurance or health care setting
Experience in provider relations and education
Understanding of healthcare quality measures STARS, HEDIS, etc.
Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
Proven analytical skills
Must be passionate about contributing to an organization focused on improving consumer experiences

Preferred Qualifications

RN license
Knowledge of Humana's internal policies and systems

Additional Information

Work at Home Guidance

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 suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
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.

Driver's License, Transportation, Insurance This role is a part of Humana's Driver Safety program and therefore requires and individual to have:

Valid state driver's license
Proof of personal vehicle liability insurance with at least $100,000/$300,000/$100,000 limits
Access to a reliable vehicle

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

You will be able to respond to the recruiters preferred response method via text, video, or voice technologies. If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication is not missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

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

Scheduled Weekly Hours

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.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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 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.

Humana jobs

Quality Improvement Professional

Community Health Worker