Quality Compliance Professional

Humana

. Participate in performance and quality improvement projects .

Posted 10/30/2026part-timeRemote • Kentucky • United StatesMid-LevelSenior💰 $71,100 - $97,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare quality improvement initiatives, particularly within the Medicaid population, while effectively conducting member outreach and performing medical record audits to enhance health outcomes. Proficient in utilizing quality measures such as HEDIS and CAHPS to drive performance improvements.

Highest-signal resume keywords

Healthcare Quality ImprovementMember Outreach ExperienceHEDIS/CMS/Quality KnowledgeCertified Professional In Healthcare Quality (CPHQ)Intermediate Excel Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality ImprovementMedical Record AuditsData AbstractionPerformance ImprovementQuality MeasuresQuality Document UpdatesProvider Compliance EvaluationCare Gap ClosureQuality Improvement Program DescriptionsState Reports Completion

Soft Skills

Self-DirectedMotivatedAbility To Work Independently

Tools & Technologies

Microsoft Office WordMicrosoft PowerPointMicrosoft Excel

Certifications & Qualifications

Certified Professional In Healthcare Quality (CPHQ)

Industry Keywords

HEDISCAHPSMedicaidQuality Improvement CommitteeNCQAKentucky Medicaid

About the role

Key responsibilities & impact

Participate in performance and quality improvement projects
Implement member- and provider-targeted interventions to improve health outcomes and experiences
Contribute to multidisciplinary committees required by NCQA and the State Contract
Participate in and potentially lead Kentucky market quality improvement activities
Conduct member outreach calls
Perform medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations
Conduct provider outreach to close care gaps
Audit records to identify improvement opportunities
Abstract data from records to close care gaps
Update quality documents, including quality improvement program descriptions, work plans, and evaluations
Attend Quality Improvement Committee meetings
Complete and update State Reports and Kentucky Medicaid Quality Improvement Committee reports
Travel quarterly to meetings in Louisville and attend provider visits as needed within Kentucky

Requirements

What you’ll need

3+ years of previous experience working with member outreach on quality and performance improvement activities
2+ years previous experience in healthcare quality improvement/quality operations
Knowledge of HEDIS/CMS/Quality
Experience with healthcare quality measures, including HEDIS and CAHPS
Comprehensive knowledge of Microsoft Office Word and PowerPoint
Intermediate Excel experience, including pivot tables/filtering, charts, and formulas
Must reside in the Eastern Time Zone
Ability to work independently under general supervision
Self-directed and motivated
Bachelor's degree preferred
Quality improvement experience with the Medicaid population preferred
Certified Professional in Healthcare Quality (CPHQ) preferred
Previous quality or process improvement experience in a hospital or physician office practice preferred

Benefits

Comp & perks

Limited benefits effective upon hire
Paid time off
401(k) retirement savings plan
Employee assistance program
Business travel and accident benefits
Remote work at home
Dedicated workspace and internet requirements to support remote work