Company name
Humana Inc.
Location
Charleston, WV, United States
Employment Type
Full-Time
Industry
Healthcare, Quality
Posted on
May 10, 2021
Profile
Description
The Senior Quality Improvement Professional will focus organizational efforts on improving behavioral health (BH)/Substance Use Disorder (SUD) clinical quality performance measures to achieve optimal performance and quality for the Humana Healthy Horizons in Kentucky Medicaid Plan. They will plan, perform, and implement cross-functional initiatives, analyze and measure the effectiveness of existing initiatives, and develop sustainable, repeatable, and quantifiable behavioral health process improvements. They will work closely with the Quality Director, Behavioral Health Director, Quality Improvement Manager and those targeting specialized behavioral health services to promote an organization-wide culture of quality improvement. Senior Quality Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
How we Value You
Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being
Responsibilities
The Senior Quality Improvement Professional uses data to develop and lead quality improvement activities and monitor performance metrics for KY Medicaid. The Senior Quality Improvement Professional assesses the need for and develops collateral materials to support BH/SUD (behavioral health (BH)/Substance Use Disorder (SUD)) providers, develops processes to share BH/SUD performance measures with providers, and assists BH/SUD practices to achieve performance and quality improvement goals. The Senior Quality Improvement Professional chairs and participates in multidisciplinary committees (internal and external) to promote quality care for Kentucky Medicaid enrollees receiving behavioral health services. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. The Senior Quality Improvement Professional works independently sometimes in ambiguous situations, and work is performed with minimal direction. Exercises considerable latitude in determining objectives and approaches to assignments. Work influences department strategy.
The Senior Quality Improvement Professional is responsible for improving clinical quality improvement and performance improvement metrics for Kentucky Medicaid behavioral health providers. This includes, but is not limited to:
Assesses need for collateral information (i.e. HEDIS tip sheets, other BH support pieces - i.e. Transitional Case Management documentation)
Develops collateral documentation needed (based on analysis above)
Develops relationships with BH/SUD Providers: Goal to provide education and improve overall performance
Provides Performance Measures and other quality related information / education to BH/SUD providers
Works with analysts to develop Performance Measure view for BH/SUD providers and identify those practices who potentially need assistance with BH performance measures (i.e. HEDIS measure analysis) Participate in QI activities designed to improve BH / SUD measures, drive provider facing Quality Improvement activities
Collaborates with internal teams (both market and Corporate based) such as BH clinical teams and provider relations to meet business objectives
Provides education directly to providers as related to medical record documentation review
Develops and submits content in both Member and Provider newsletters to support Quality and Performance Measure improvement
SME for all member and provider BH content for documents such as the Enrollee Newsletter, Provider Manual, and quality documents
Develops and manages a repository of approved provider and member collateral information
Other activities as assigned
Must be able to travel to provider practices in either the eastern or the western half of the state.
Travel up to 50% of the time (within Kentucky) to meet with and support BH/SUD providers.
Required Qualifications
Active Kentucky licensed clinician including: Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPCC), Registered Nurse with behavioral health experience
3 years of current experience working with a complex behavioral health Medicaid population and knowledge of various types of behavioral health service criteria, specifically Kentucky Medicaid behavioral health requirements
2 years of experience monitoring and improving behavioral health quality measures (example HEDIS or CAHPS) in a quality operations / quality management or office based practice setting
Previous experience working with behavioral health providers on quality and performance improvement activities
Demonstrated ability to perform moderate to complex data analysis
Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel
Strong relationship building skills
Excellent written and oral communication skills
Must be passionate about contributing to an organization focused on continuously improving quality for our members
Ability to work independently under general instructions, must be self-directed and motivated
Preferred Qualifications
Bachelor's degree in Business, Healthcare, or related field
Certified Professional in Healthcare Quality (CPHQ)
Experience with quality improvement methodology such as plan-do-study-act
Advanced degree in business, healthcare, or related field
Project management experience
Strong business skills, including sales and marketing objectives
Previous experience developing provider facing educational materials
Detail orientated and comfortable working with tight deadlines in a fast paced environment
Additional Information
Must be able to travel to provider practices in either the eastern or the western half of the state.
Travel up to 50% of the time (within Kentucky) to meet with and support BH/SUD providers.
Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required
Our Hiring Process
As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews
If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m (satellite and/or wireless internet connections are NOT permitted for Work at Home roles) and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process. #ThriveTogether #WorkAtHome
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com