Quality Improvement Program Lead (National Medicaid Quality) - Humana
Dover, DE
About the Job
Become a part of our caring community and help us put health first
Humana Healthy Horizons is seeking a Quality Improvement Program Lead who will be responsible for the end to end ownership of Humana Healthy Horizon's National Quality Improvement (QI) efforts, capability advancement activities, and the development and maintenance of QI frameworks and toolkits to support Quality associates throughout the line of business. The Quality Improvement Program Lead reports directly to the National Medicaid Quality Director.
The Quality Improvement Program Lead exercises independent judgment and decision making on complex issues within their scope, works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.
Responsibilities include:
+ Provides direction and oversight of Humana’s QI programs management model and improvement strategy for the Medicaid line of business at the national level.
+ Develops policy and procedure, and defines/improves processes regarding quality measurement data collection and improvement methodology for all initiatives impacting Medicaid beneficiaries.
+ Develops and maintains QI methodology play books and tool kits to support market QI efforts.
+ Serves as the lead of the Quality related functions related to NCQA’s Health Equity Accreditation.
+ Oversees related work plan development and evaluation of programs across all Medicaid markets.
+ Nurtures relationships with national and market partners to expand and strengthen quality improvement efforts.
+ Ensures organizational awareness of key developments and leads in identification and development of national quality interventions.
+ Drives interdepartmental collaboration to achieve business goals.
Use your skills to make an impact
Required Qualifications
+ Bachelor's degree
+ 3+ years of experience managing Healthcare Quality programs OR 8+ years of quality improvement experience.
+ 5+ years of experience monitoring and improving quality measures (example HEDIS or CAHPS) in a quality improvement / quality management or office-based practice setting.
+ Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel.
+ Demonstrated ability to perform moderate to complex data analysis.
+ Strong relationship building skills.
+ Excellent written and oral communication skills.
+ Ability to work independently under general instructions, must be self-directed and motivated.
Preferred Qualifications .
+ Certified Professional in Healthcare Quality (CPHQ)
+ Experience with quality improvement methodology, preferably with the IHI Model for Improvement. Lean/Six Sigma, or other standardized methodology.
+ Experience with SharePoint design.
+ Advanced degree in business, healthcare, or related field.
+ Project management experience.
+ Strong business acumen.
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
+ Associates 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 associates 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
Additional Information
+ Training: Virtual in your home office
+ Travel: up to 10%
+ Work Hours: Eastern Standard Time (EST)
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Be sure to check your junk/spam folder so you do not miss it.
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.
$112,400 - $154,900 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
Humana 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.
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.
Humana Healthy Horizons is seeking a Quality Improvement Program Lead who will be responsible for the end to end ownership of Humana Healthy Horizon's National Quality Improvement (QI) efforts, capability advancement activities, and the development and maintenance of QI frameworks and toolkits to support Quality associates throughout the line of business. The Quality Improvement Program Lead reports directly to the National Medicaid Quality Director.
The Quality Improvement Program Lead exercises independent judgment and decision making on complex issues within their scope, works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.
Responsibilities include:
+ Provides direction and oversight of Humana’s QI programs management model and improvement strategy for the Medicaid line of business at the national level.
+ Develops policy and procedure, and defines/improves processes regarding quality measurement data collection and improvement methodology for all initiatives impacting Medicaid beneficiaries.
+ Develops and maintains QI methodology play books and tool kits to support market QI efforts.
+ Serves as the lead of the Quality related functions related to NCQA’s Health Equity Accreditation.
+ Oversees related work plan development and evaluation of programs across all Medicaid markets.
+ Nurtures relationships with national and market partners to expand and strengthen quality improvement efforts.
+ Ensures organizational awareness of key developments and leads in identification and development of national quality interventions.
+ Drives interdepartmental collaboration to achieve business goals.
Use your skills to make an impact
Required Qualifications
+ Bachelor's degree
+ 3+ years of experience managing Healthcare Quality programs OR 8+ years of quality improvement experience.
+ 5+ years of experience monitoring and improving quality measures (example HEDIS or CAHPS) in a quality improvement / quality management or office-based practice setting.
+ Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel.
+ Demonstrated ability to perform moderate to complex data analysis.
+ Strong relationship building skills.
+ Excellent written and oral communication skills.
+ Ability to work independently under general instructions, must be self-directed and motivated.
Preferred Qualifications .
+ Certified Professional in Healthcare Quality (CPHQ)
+ Experience with quality improvement methodology, preferably with the IHI Model for Improvement. Lean/Six Sigma, or other standardized methodology.
+ Experience with SharePoint design.
+ Advanced degree in business, healthcare, or related field.
+ Project management experience.
+ Strong business acumen.
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
+ Associates 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 associates 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
Additional Information
+ Training: Virtual in your home office
+ Travel: up to 10%
+ Work Hours: Eastern Standard Time (EST)
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Be sure to check your junk/spam folder so you do not miss it.
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.
$112,400 - $154,900 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
Humana 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.
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.
Source : Humana
