Sr Quality Compliance Professional - Maternal Child Health

Profile

Description

Responsibilities

The Senior Quality Compliance Professional uses quality compliance and improvement tools and methodology to assess, implement, and evaluate activities to monitor and continuously improve EPSDT and maternal health services and rates for Louisiana 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 frequently required to interpret and analyze data to identify new creative interventions to increase EPSDT screening rates, improve access to pregnancy related services, independently determine an appropriate course of action, and present these ideas/plans to governance teams/committees. They assess educational needs of internal and external teams around EPSDT and maternal health services in order to develop and implement plans to increase knowledge.

The primary functions of this role include:

Ensure delivery of EPSDT Services;

Ensure delivery of maternal and postpartum care;

Promote family planning services;

Promote preventive health strategies;

Identifying and coordinating assistance for identified enrollee needs specific to maternal/child health and EPSDT;

Interfacing with community partners

Interfacing with the Office of Public Health-Bureau of Family Health and other child-serving state health agencies to coordinate resource and information sharing around provision of EPSDT services.

Required Qualifications

Licensed in the state of Louisiana as one of the following:

Registered Nurse

Advance Practice Registered Nurse

Physician's Assistant OR

Master's degree in health services, public health, or health care administration or another related field

Certified Professional in Health Care Quality (CPHQ)

Certified Health Care Quality Management (CHCQM)

At least 3 years of experience in either delivering EPSDT services OR Health Care Quality Improvement

This position will be Work at Home, but needs to live within a 1 hour commute of Baton Rouge, LA or New Orleans, LA and the ability to travel in to meet with internal or external stakeholders in person when needed (could be a few times a month)

Prior experience in a fast paced insurance or health care setting

Knowledge of EPSDT and Child Health Services

Knowledge of Maternal and Pregnancy related services

Understanding of healthcare quality measures (example HEDIS)

Comprehensive knowledge of Microsoft Office products

Excellent communication skills, both oral and written, ability to present to large groups

Preferred Qualifications

Certified Professional in Health Care Quality (CPHQ)

Advanced Practice Provider (Physician Assistants; Nurse Practitioner, Certified Nurse Midwife)

Experience developing provider and member education

Advanced Excel experience (pivot tables, charts, formulas)

Knowledge of Humana's internal policies, procedures and systems

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 25x10 (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

#LI-JB2

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com