Quality Improvement Manager

Profile

Description

The Manager, Quality Improvement implements quality improvement programs for the Kentucky Medicaid line of business. This includes quality compliance and quality improvement activities such as the annual Quality Improvement program description, work plan, and annual evaluation, as well as oversees, plans, and implements new and existing health plan quality improvement initiatives, including Performance Improvement Projects (PIPs), medical records documentation audits, and Early Periodic Screening Diagnosis and Testing (EPSDT). The Manager, Quality Improvement 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.

Responsibilities

The Manager, Quality Improvement is responsible for monitoring and implementing activities related to quality improvement and quality compliance for both behavioral and physical health. The Manager, Quality Improvement is responsible for developing, implementing and monitoring the success of the quality assurance and performance improvement program and monitoring the success of quality improvement interventions, including EPSDT. These activities include but are not limited to the quality assurance and performance improvement program description, quality improvement work plan, quality evaluation, performance improvement projects, quality improvement activities for both physical and behavioral health and medical record documentation audits. The Manager, Quality Improvement works to coordinate resources and manages department reporting, audits processes as needed for compliance, completes and submits reports to internal committees and state regulators as required for clinical studies.

Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.

Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Leads a team of both clinical and non-clinical associates.

This role will travel to Frankfort, Kentucky as needed for state meetings and participate in other internal and external multidisciplinary meetings. (See additional Information)

Required Qualifications

Bachelor's degree in nursing, Public Health or other Health Care Related Field

3 or more years leadership experience to include hiring, training & coaching

3 or more years' experience in a fast-paced insurance or health care setting

Experience in direct provider and member engagement

3 or more years' experience with healthcare quality measures such as STARS, HEDIS, CAHPS.

Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint

Proven Data Analytical skills

Full understanding of the quality assurance and performance improvement program description, quality improvement work plan, quality evaluation, performance improvement projects using PDSA

This role will travel as needed for state meetings and participate in other internal and external multidisciplinary meetings. (See additional Information)

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

Preferred Qualifications

Knowledge of Humana's internal policies, procedures and systems

Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn't missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone 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.

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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