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

Are you ready to make a lasting impact on healthcare quality? We’re looking for a dynamic Director of Quality Improvement to lead the charge in designing and executing innovative quality improvement programs across all business lines. In this influential role, you’ll craft and drive annual process improvement projects, quality reporting, and quality compliance monitoring, ensuring we continually raise the bar for excellence.

Key responsibilities include:

• Oversees HEDIS, CAHPS, Star ratings, and other State-required measure reporting and evaluation.
• Operates an NCQA compliant quality program.
• Ensures compliance with State health and safety standards, quality-of-care investigations, and reporting.
• Implements quality improvement projects, both clinical and non-clinical, that show substantial improvements year-over-year.
• Improves quality measure performance through innovative approaches to engage members and providers.
• Uses actionable analytics in daily operations, wielding business intelligence, care coordination, and claims system tools to identify issues, mitigate risks, and develop solutions.
• Analyzes dashboards consisting of Key Performance Indicators (KPI) and non-KPI metrics, interpreting trends and significant variances to improve outcomes.
• Enhances value-based reimbursement models with incentives for providers to improve the delivery of quality care.
• Provides oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation.
• Serves 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.

Use your skills to make an impact

Required Qualifications

• Registered Nurse (RN), physician or physician’s assistant licensed in the state of Wisconsin without restriction, or certification 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. If the candidate does not possess one of the certifications, they must be able to obtain certification within 6 months from date of hire.
• Bachelor’s degree in a field related to healthcare quality. These fields may include, but are not limited to, nursing, education, public health, health administration, health policy, business or computer science.
• Minimum five (5) years of experience in quality improvement/quality assurance in the healthcare field.
• Minimum three (3) years of leadership/management experience.
• Prior Medicare or Medicaid health plan experience.
• Must be able to travel up to 25% of your time to WI as needed for required meetings and conferences.

Preferred Qualifications

• Master's degree in any field related to healthcare quality.
• CPHQ (Certified Professional in Healthcare Quality) Certification, or comparable achievement.
• Clinical program development and implementation experience.
• Strong understanding of NCQA Health Plan Accreditation standards and requirements.
• Experience with matrixed organizations.
• Knowledge of Humana's internal policies, procedures, and systems.
• Knowledge of acute and primary medical HMO policies and procedures.
• Knowledge of long-term care supports and services policies and procedures.

Additional Information

• Workstyle: Home: Associates Home office environment is their primary work location, but they will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
• Travel: Up to 25% throughout the State of WI
• Typical Workdays/Hours: Monday – Friday, 8:00 am – 5:00 pm CST

WAH Internet Statement

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.
• 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.

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.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [email protected] with instructions on how to add the information into your official application on Humana’s secure website.

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our 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, Medicaid, families, individuals, military service personnel, and communities at large.

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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.