Director Quality Improvement - Ohio Medicaid Remote Ohio

Profile

Description

The Director, Quality Improvement implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Director, Quality Improvement requires an in-depth understanding of how organization capabilities interrelate across departments.

Responsibilities

The Director, Quality Improvement provides strategic leadership for Humana's Ohio Medicaid Quality Program, in alignment with organizational quality and population health goals and ensuring compliance with all contract, state, and federal requirements. They will support NCQA accreditation and will serve as the local market lead for accreditation compliance. The Associate Director, Quality Improvement has oversight of quality investigations and compliance processes, including evaluating and investigations into quality of care concerns. This position has primary responsibility to operate a quality management infrastructure which promotes member safety, quality of care, improves health disparities, is culturally competent and assures cost effective access to care in the safest, least restrictive setting. This role requires 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.

Operate an NCQA compliant quality program.

Oversee the development, implementation and management of quality improvement projects and work collaboratively to address health equity and social determinants of health.

Partner with Population Health Director to inform population health strategy and target improvement areas including the design of clinical programs that improve health outcomes and reduce health disparities.

Oversee HEDIS, CAHPS, and ODM required measure reporting and evaluation.

Ensure compliance with quality of care investigations and reporting.

Provide oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program 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, utilizing 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.

Responsible for maintaining confidential information in accordance with policies, and state and federal laws, rules and regulations regarding confidentiality.

Required Qualifications

Registered Nurse (RN), physician or physician's assistant licensed in the state of Ohio without restrictions or be certified as a Certified Professional in Health Care Quality by the National Association for Healthcare Quality (NAHQ), Certified QI Associate by the American Society for Quality, and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers.

Bachelor's Degree in nursing, public health, health administration, health policy or business.

Minimum five (5) years of experience in Quality Improvement/Quality Assurance in the healthcare field.

Minimum three (3) years of leadership experience.

Clinical program development and implementation experience.

Strong understanding of NCQA Health Plan accreditation standards and requirements.

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.

Understanding of value based payment models that reward quality improvement.

Understanding of cultural factors that influence health outcomes and implementing culturally competent improvement interventions.

Experience implementing rapid-cycle improvement techniques that demonstrated material improvements.

Excellent communication skills and experience in cross-functional collaboration in matrixed organizations.

Must reside in the state of Ohio.

This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Must have a room in your home designated as a home office; away from high traffic areas where confidential information may be secured.

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

Preferred Qualifications

Master's Degree in nursing, public health, health administration, health policy or business.

CPHQ (Certified Professional in Healthcare Quality) Certification.

Knowledge of Humana's internal policies, procedures and systems.

Additional Information

Travel: up to 25% to Columbus, OH and vicinity.

Direct Reports: up to 8

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Montage/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 correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. 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.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com