Humana Looking For Senior Medicaid Quality Improvement, Clinical Professional (Remote)Kentucky at West Virginia Full Time

The Senior Medicaid Quality Improvement, Clinical Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve quality performance within the contracted working relationship with the health plan. 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 Medicaid Quality Improvement, Clinical Professional develops provider relationships to:

• Collaborates on strategy to improve HEDIS Quality Rates, Population Health /Clinical management, Documentation and Coding
• Focuses on improving provider and member experience
• Enhances data sharing and connectivity
• Contributes to department strategy to improve operational excellence
• Makes decisions on moderately complex to complex issues regarding technical approach for project components
• Works independently to determine objectives and approaches

Required Qualifications

• 2+ years of experience with a strong knowledge around Medicaid/Medicare HEDIS quality measures
• 2+ years of Health care or managed care experience in a Provider facing role
• Bachelor’s Degree or RN license
• Proven planning, preparation and presenting skills
• Demonstrated ability to manage multiple projects and meet deadlines
• Proficient in all aspect of Microsoft Office to include Word, Excel, Outlook and PowerPoint
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Established knowledge of reimbursement and bonus methodologies
• ​Comprehensive knowledge of KY Medicaid policies, processes and procedures

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required
• Satellite and Wireless Internet service is NOT allowed for this role
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information

• Provider Facing Role
• Candidate will travel throughout the state of Kentucky 25%-50% of the time and must live within a commutable distance to the border of Kentucky
• Currently adhering to COVID travel policy

For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

• Provide proof of full vaccination, including booster or commit to testing protocols OR  
• Provide proof of applicable exemption including any required supporting documentation

​Medical, religious, state, and remote-only work exemptions are available.

Scheduled Weekly Hours**

40

Job Type: Full-time

Schedule:

Application Question(s):

• Do you have at least 2 years of Health Care or Managed Care experience in a Provider facing role.

Work Location: Multiple Locations