Quality Improvement Director

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 The Director, Quality Improvement leads the development, implementation, and evaluation of quality improvement programs across all lines of business, including the annual program description, work plan, and annual evaluation. You will have accountability for quality withhold performance, including monitoring results, identifying improvement opportunities, and driving strategies to optimize performance outcomes.
The Director partners across matrixed and cross-functional teams, including teams outside of the direct reporting structure, to improve market quality goals and ensure agreement on priorities. We ask that you have deep expertise in HEDIS, CAHPS, and performance improvement, as well as the ability to lead teams and influence stakeholders across the organization. The QI Director supports resolving complex technical and operational problems within department(s) and leads multiple associates and highly specialized professional associates.

Job Description

The Director, Quality Improvement leads quality investigations, compliance oversight, and quality improvement operations across all lines of business. This role is accountable for the administration of the quality management system. It is also responsible for oversight of department reporting and documentation platforms. Furthermore, the role executes audit and monitoring activities to ensure compliance with internal, state, and federal requirements. The Director also has responsibility for quality withhold performance, including monitoring results, identifying gaps, and driving improvement strategies to support achievement of enterprise quality goals. You will support NCQA accreditation and will serve as the local market lead for accreditation compliance.

You will ensure accurate and timely preparation and submission of required reports to all regulators. You will collaborate across matrixed and cross-functional teams, including those not directly led by the incumbent, to support implementation of new and revised programs, large-scale initiatives, and operational process improvements. You will exercise broad decision-making authority related to program execution, technical and operational procedures, and performance optimization, while contributing to functional strategy and advancing organizational goals. We are looking for commitment to cross-functional collaboration to drive continuous quality improvement throughout health plan operations, provider network and community partnerships to achieve our quality improvement goals and objectives.

Additional Job Description

• Direct HEDIS project deliverables, driving results and improvement by population stream.
• Align Quality and Population Health strategies.
• Provide strategic oversight of Cross-stream Quality Withhold collaborative efforts.
• Direct efforts on maintaining quality documentation including policies/procedures, committee minutes/materials, and program documents. Provide oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation.
• Directs efforts on maintaining NCQA and EQRO compliance.
• Maintain confidential information in accordance with policies, and state and federal laws, rules, and regulations regarding confidentiality.
• Oversee the development, implementation and management of quality improvement projects including required contract required Performance Improvement Projects (PIPs)
• Work collaboratively with OHCA and others to improve health outcomes.
• Oversee HEDIS, CAHPS, and OHCA required measure reporting and evaluation.
• Improve quality measure performance through innovative approaches in engaging members and providers.
• Analyze dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes.
• Incorporate actionable analytics, using business intelligence tools, care coordination tools, and claims systems to identify issues, mitigate risks, and develop solutions.
• Serve on standing committees of governance and quality management.

Use your skills to make an impact
 

Required Qualifications

• Bachelors degree in Public Health, Health Administration, Business Administration, Nursing, Healthcare Quality, or a related healthcare or clinical field.
• Minimum five (5) years of experience in Quality Improvement/Quality Assurance in the healthcare field
• 3 or more years of current or previous leadership experience (Ideally any experience in leading quality improvement and/or compliance professionals).
• Prior experience in a fast-paced insurance or health care setting
• Experience in provider relations and education
• Understanding of healthcare quality measures STARS, HEDIS, etc.
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
• Proven analytical skills
• Prior experience demonstrating relationship management and stakeholder engagement skills, with the ability to build strategic partnerships, align diverse teams, and drive results across functions and organizational levels
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Knowledge of QI methodologies (i.e. IHI model of improvement and familiarity with QI Tools (i.e. FMEA, KDD, workflows/diagrams, root cause analysis etc..)
• Experience in Quality Improvement/Process Improvement in the healthcare field
• Demonstrated skills in quality improvement concepts, health care data analysis, data mining methods and the identification of population health issues, trends, and health disparities using health care data sources.
• Excellent oral and written communication and presentation skills, with a demonstrated ability to effectively represent the organization and the health plan to a broad range of internal and external stakeholders.
• Critical thinker who can anticipate team needs and take initiative to present ideas, ask the right questions and deliver the highest quality work.
• This role requires regular weekly travel to the office in Oklahoma City, OK

Preferred Qualifications

• Master's degree in Public Health, Health Administration, Business Administration, Nursing, Healthcare Quality, or a related healthcare or clinical field.
• Knowledge of Humana's internal policies, procedures and systems
• CPHQ (Certified Professional in Healthcare Quality) Certification.
• Previous experience with value-based payment models that reward quality improvement.
• Experience working within Medicaid
• History of developing business cases, assess return on investment (ROI), and translate data into actionable recommendations that support health plan performance and value

Work at Home 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

 

$126,300 - $173,700 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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.