Become a part of our caring community and help us put health firstThe Senior Quality Compliance Professional uses quality compliance and improvement tools and methodology to assess, implement, monitor and evaluate activities to continuously improve compliance with EPSDT services and close gaps in care for Oklahoma Medicaid enrollees. The Senior Quality Compliance Professional has proven data analysis skills and a strong knowledge of EPSDT and maternal health requirements.
The Senior Quality Compliance Professional is required to understand compliance with quality measures and be able to analyze and interpret healthcare data/information in order to develop strategy and build interventions to close gaps in care. More specifically, the role will be focusing on increasing EPSDT screening / childhood immunization rates, improve access to pregnancy related services and work on additional projects aligning with OHCA priorities.
The primary functions of this role include:- Tracks compliance with, and educates member on receipt of EPSDT required services;
- Identifies and coordinates assistance for member needs specific to maternal/child health and EPSDT;
- Analyses immunization data and contributes to strategy development to address gaps in care;
- Participate in EPSDT, maternal health and child quality performance improvement projects (PIPs);
- Independently determine an appropriate course of action and present ideas/plans to governance teams/committees;
- Prepares state reporting related to EPSDT, participates on annual program evaluation;
- Interfaces with care managers and pregnancy related services coordinators, the health equity team, and represents the department in EPSDT related events with community partners.
- Additional responsibilities as assigned by leader.
Use your skills to make an impactRequired Qualifications
Senior Quality Compliance Professional must meetoneof the following requirements:
- Unrestricted Registered Nurse in the State of Oklahoma OR
- Physician's Assistant OR
- Master's degree in health services, public health, or health care administration or another related field OR
- Certified Professional in Health Care Quality (CPHQ) OR
- Certified Health Care Quality Management (CHCQM)
Additional qualification as follows:
- Must have at least 3 years of experience in either delivering EPSDT services OR Health Care Quality Improvement
- Must have comprehensive knowledge of Microsoft Office Outlook, Word and PowerPoint
- Intermediate level of Excel is required (experience with pivot tables, charts, formulas)
- Must reside in Oklahoma, preferably Oklahoma City
Preferred QualificationsAdvanced Excel
Understanding of healthcare quality measures (example HEDIS)
Knowledge and experience of EPSDT and Child Health Services (ie. childhood immunization measures)
Excellent communication skills, both oral and written, ability to present to large groups.
Additional InformationThis is a HYBRID position.Availability to work in Humana's Oklahoma Tower facility in Oklahoma City.
Work at Home CriteriaTo 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.
Interview FormatAs part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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.
#B2
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.
$78,400 - $107,800 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 usHumana 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 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.