The Manager, Quality Compliance will implement and monitor quality improvement program components, including the annual program description, work plan, and annual evaluation. The Manager, Quality Compliance works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Manager, Quality Compliance will play a key role in the NCQA accreditation process.
POSITION RESPONSIBILITIES:
- Ensure the Quality Assessment and Performance Improvement (QAPI) program for Humana Healthy Horizons in Michigan operates effectively.
- Drive quality improvement efforts of Humana’s Quality Operations.
- Support the implementation and monitoring of program documents such as the Quality Improvement Plan, work plan, QAPI committee and evaluation, as well as other quality operations, improvement, and compliance functions.
- Audit processes as needed for compliance.
- Complete and submit state, federal, or other reports as required.
- Collaborate and maintain frequent contact with other managers across departments and health plan.
- Conduct briefings and area meetings.
- Determine the plan’s compliance with requirements for NCQA accreditation.
- Track HEDIS measures along with the assistance of the Quality Data Analyst to ensure the plan meets the goals set for quality measure withholds.
- Coordinate with relevant internal/external stakeholders, providers, the Michigan Department of Health and Human Services (MDHHS), and other entities to maintain quality operations and improve health outcomes.
- Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving the quality departmental area.
Use your skills to make an impact
REQUIRED QUALIFICATIONS:
- Must reside in Michigan or within 40 miles of the border in Indiana or Ohio.
- Bachelor's Degree or 5+ years related work experience in healthcare quality improvement.
- 2 or more years of management/leadership experience.
- Understanding of healthcare quality measures STARS, HEDIS, etc.
- Prior experience in a fast-paced insurance or health care setting.
- Comprehensive knowledge of Microsoft Office suite.
- Excellent communication skills, both oral and written.
PREFERRED QUALIFICATIONS:
- CPHQ (Certified Professional in Healthcare Quality) Certification.
- Master's degree in a related field.
- Proven analytical skills.
- Knowledge of Humana's internal policies, procedures and systems.
- Experience in provider relations and education.
- Experience with NCQA accreditation.
- Understanding of Quality Improvement tools and methodologies (PDSA, root cause analysis, IHI Model for Improvement, etc.).
Additional Information
WAH Internet Statement
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 required; 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.
Scheduled Weekly Hours
40Pay 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.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
Top Skills
What We Do
At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
