Role Description Humana Illinois Market is seeking a Quality Improvement Professional who analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable business process improvements. The Quality Improvement Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Some experience in project management is also desired. In this role, the professional must understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. - Research best business practices within and outside the organization to establish benchmark data. - Collect and analyze process data to initiate, develop, and recommend business practices and procedures that focus on enhanced safety, increased productivity, and reduced cost. - Design, communicate, and implement an operational plan for completing a project. - Monitor progress and performance against the project plan to resolve problems and minimize delays. - Perform CMS and State audits focused on improving compliance and quality. - Focus audits may include annual and initial HRA compliance, Critical Incident audits, post discharge and transition of care contacts. - Provide Source System Validations for Universe and State reports. - Prepare cases, present cases and/or provide navigation responsibilities for CMS audits and State audits. - Participate and present in reports for Quality Improvement Committee and other committees as needed. - Collaborate with Managers, Senior Care Coordinators, and Care Coordination staff for remediations identified on audits. - Assist in special projects as needed. - Development and review of internal quality metrics. - Support process improvement initiatives. - Assist in reviewing new Job Aids to support the team of Learning Design and Learning Facilitation staff. - Review current Job Aids and Policies and Procedures as requested. - Create and present education as requested by the Process Improvement Lead. - Support Operations Managers in quality improvement initiatives. - Assist Managers in communicating audit findings to individuals and teams. - Participate in Interrater Reliability (IRR) meetings and assist in the development of Interpretation Standards to guide audit scoring and increase consistency across the Process Improvement Team. - Participate in root cause analysis research for audits. Qualifications - Bachelor's degree. - 2 years of experience related to process improvement, compliance measures, or auditing practices or 2 years of experience in Medicaid/Medicare Care Coordination. - Prior project management experience. - Ability to travel to Schaumburg office at minimum 2-4 times yearly for State and CMS Mock audits. - Occasional travel to Louisville for an extended period during CMS Audits. - Excellent analytical skills, able to manipulate and interpret data. - Ability to work within highly structured contractual time compliance requirements with occasional short turnaround time. Requirements - Knowledge of HEDIS/Stars/CMS/Quality. - Experience in Medicaid or Medicare Guidelines. - Detail oriented and comfortable working with tight deadlines in a fast-paced environment. - Intermediate knowledge of Smartsheet. - Six Sigma or Project Management certification. Benefits - Medical, dental, and vision benefits. - 401(k) retirement savings plan. - Time off (including paid time off, company and personal holidays, paid parental and caregiver leave). - Short-term and long-term disability. - Life insurance. - Many other opportunities. Company Description Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large.