Director, Quality Improvement

Humana; Baton Rouge (LA); Hybrid; USD 126,000 - 174,000; Full time

Job summary

Join a forward-thinking organization dedicated to enhancing healthcare quality and operational excellence. As the Director of Quality Improvement, you'll implement vital programs across various business lines, ensuring compliance and driving strategic initiatives. This role demands a seasoned professional with a strong background in healthcare operations and quality measures. With a focus on collaboration and relationship-building, you'll play a key role in shaping the department's strategy and enhancing performance. If you're passionate about making a meaningful impact in the healthcare sector, this opportunity is for you.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Plan

Paid Time Off

Disability Insurance

Life Insurance

Qualifications

• 5+ years management experience in operations.
• Knowledge of healthcare quality measures such as STARS and HEDIS.

Responsibilities

• Manages the quality management system and conducts compliance audits.
• Prepares reports for CMS and state regulators.

Skills

Management Experience

Healthcare Quality Measures

Analytical Skills

Communication Skills

Relationship Building

Education

Master's Degree

Louisiana-licensed Registered Nurse

Tools

Microsoft Office

Power BI

Job description

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

The Director, Quality Improvement implements quality improvement programs for all lines of business, including the development of annual program descriptions, work plans, and evaluations. This role requires an in-depth understanding of how organizational capabilities interrelate across functions or segments.

The Director monitors quality investigations and compliance processes.

Role Overview:

1. Manages the quality management system, department SharePoint, and reporting. Conducts audits for compliance as needed.
2. Prepares and submits reports to CMS and state regulators for clinical studies.
3. Decides on the implementation of new or updated programs and large-scale projects, supporting technical and operational procedures. Implements strategic plans, drives goals, and enhances performance.
4. Contributes to the development of the department's strategy.

Use your skills to make an impact

Required Qualifications:

• Master's Degree
• Louisiana-licensed registered nurse, advanced practice registered nurse, physician, physician's assistant, or certified healthcare quality professional (CPHQ or CHCQM).
• 5+ years management experience in operations
• 5+ years supervisory experience
• 5+ years in a fast-paced insurance or healthcare setting
• 3+ years provider relations and education experience
• Knowledge of healthcare quality measures (e.g., STARS, HEDIS)
• Proficiency in Microsoft Office (Word, Excel, PowerPoint)
• Strong analytical and communication skills
• Ability to build relationships
• Residency and work in Louisiana required
• Willingness to travel up to 25%; hybrid role
• Knowledge of Value-Based Contracting

Preferred Qualifications:

• Knowledge of Humana's policies and systems
• Six Sigma or similar quality management training
• Experience with Power BI and pivot tables

Additional Information

Work-At-Home Requirements:

• Internet speed of at least 25 Mbps download and 10 Mbps upload; wired connection preferred.
• Satellite, cellular, or microwave connections require leadership approval.
• Employees in California, Illinois, Montana, or South Dakota receive internet expense reimbursement.
• Humana provides necessary telephone equipment.
• Dedicated workspace to protect member PHI/HIPAA information.

Interview Process:

We use HireVue for interviews, including a SMS Text Messaging interview. If selected, you will receive an email with instructions. Please check your spam folder.

SSN Alert:

Applicants may be asked to provide their SSN via a secure link from [e-mail].

Work Hours and Compensation:

40 hours/week. Salary: $126,300 - $173,700/year. Bonus potential based on performance.

Benefits:

Humana offers medical, dental, vision, 401(k), paid time off, disability, life insurance, and more.

About us

Humana is committed to health and well-being, providing services that support better quality of life for diverse populations.

Equal Opportunity Employer

Humana values diversity and is an equal opportunity employer, committed to fair employment practices.

About the company

Humana partners with individuals to create personalized paths to health.