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Senior Quality Improvement Professional

Humana

Humana

Quality Assurance
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Posted on Friday, June 7, 2024

Become a part of our caring community and help us put health first

Humana Healthy Horizons in Indiana is seeking a Senior Quality Improvement Professional who will implement quality improvement programs and support the Quality Assurance and Performance Improvement Program for Indiana Pathways Program/Humana Medicaid including annual program description, work plan, annual evaluation, and the management, tracking, and reporting of Performance Improvement Projects. The work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Position Responsibilities:

  • Monitors quality compliance processes.
  • Participates in interdepartmental projects and activities.
  • Develops and implements performance improvement projects and oversees PIP's related day-to-day activities.
  • Acts as lead liaison with internal stakeholders and business partners in the collection of data and intervention information or delegates this responsibility to team members as needed.
  • Monitors and audits processes as needed for compliance.
  • Ensures that CMS protocols for PIPs are followed and that all steps outlined in the CMS protocols for performance improvement projects are documented.
  • Monitors and tracks measures and develops internal strategies for improvement.
  • Makes decisions on moderately complex to complex issues regarding technical approach for project components.
  • Performs duties with minimal direction.
  • Exercises considerable latitude in determining objectives and approaches to assignments.


Use your skills to make an impact

Required Qualifications

  • Five (5)+ years of work experience in a health insurance or health care setting.
  • Experience working with healthcare quality measures, i.e. HEDIS/STARS/CMS/Operational Quality.
  • Proficient in Microsoft Office Word, Excel and PowerPoint.

Preferred Qualifications

  • Bachelor’s degree.
  • Experience with Long Term Care programs or related populations.
  • Registered Nurse, Licensed Practical Nurse (LPN), or Master’s/Bachelor’s in social work.
  • Strong business skills, including sales and marketing objectives.
  • Excellent communication skills, both oral and written.
  • Strong relationship-building skills.

Additional Information:

  • Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
  • Work Location: Indiana resident preferred.
  • Typical Work Days/Hours: Monday – Friday, 8:00 am – 5:00 pm EST.

WAH Internet 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 recommended; 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.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

  • Health benefits effective day 1
  • Paid time off, holidays, volunteer time and jury duty pay
  • Recognition pay
  • 401(k) retirement savings plan with employer match
  • Tuition assistance
  • Scholarships for eligible dependents
  • Parental and caregiver leave
  • Employee charity matching program
  • Network Resource Groups (NRGs)
  • Career development opportunities

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Nationwide Remote - This is a remote nationwide position.

According to the Indiana Office of Inspector General Rule, 42 IAC 1-5-14 Post-Employment Restrictions, if you are a current or former state officer, employee or special state appointee with Indiana Family and Social Services Administration (FSSA) within the past year, engaged in the negotiation or the administration of a Medicaid contract on behalf of the state and/or Family and Social Services Administration (FSSA); in a position to make discretionary decision affecting the: (1) outcome of the negotiation; or (2) nature of the administration; or either engaged in making a regulatory or licensing decision that directly applied to Humana Inc. or to a parent or subsidiary you cannot be considered for this opportunity. For more information please visit: IG: Indiana Office of Inspector General

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.


$76,800 - $105,800 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, 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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.