Job Description

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

Humana is seeking a Quality Improvement Professional to join the Wisconsin Medicaid Market team. The Quality Improvement Professional monitors incident investigations and compliance processes; manages the incident management system and processes, department SharePoint, and department reporting; audits processes as needed for compliance; completes and submits reports to state regulators as required.

• Implement quality improvement initiatives related to incident management.
• Manage the Incident Management System (IMS) that connects to the state reporting system.
• Review, triage, and process incident reports, quality alerts, and program integrity events applying critical thinking skills to ensure sufficient detail and appropriate follow up and regulatory compliance.
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• Act as a resource to Care Management by providing guidance and education around incident investigation and follow up.
• Collaborate with Quality Management Leadership and other Departments to ensure appropriate and timely response to immediate member risk or concerns.
• Assist with the collection, organization, and evaluation of data from incidents, events, quality alerts, and statements of deficiency as a means to identify and address systemic quality concerns.
• Ensure opportunities for stakeholder involvement in activities aimed at supporting quality through the monitoring of incidents and events.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree or more advanced degree in the human services area (Social work, Sociology, Psychology or Nursing) and a minimum of one year experience working with elders, adults with physical disabilities or adults with intellectual disabilities OR bachelor’s degree or more advanced degree in any area other than human services with a minimum of 3 years’ experience working with elders, adults with physical disabilities or adults with intellectual disabilities.
• 3 years’ experience in a health insurance, health care, or long-term services and support setting.
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint.

Preferred Qualifications

• Experience in WI long-term care programs, Family Care or Family Care Partnership, providing care management support to elders and/or adults with physical or intellectual disabilities.
• Experience in data collection, analysis, and reporting.

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.  
• Work Location: must reside in Wisconsin.
• Travel: minimal travel within Wisconsin may be required.  
• Typical Work days/hours: Monday – Friday, 8:00 am – 5:00 pm Central Standard Time (CST)

WAH Internet Requirements

To 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.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

HireVue

As 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.

Limited Geography Remote - This is a remote position but located within a specific geography.

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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.

 

$63,400 - $87,400 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
 

About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our 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, 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.