Remote Quality Improvement Director

Humana Inc; Oklahoma City (OK); Remote; USD 126,000 - 174,000; Full time

Job summary

Humana Inc. is seeking a Director, Quality Improvement to lead development, implementation, and evaluation of quality programs across all lines of business.

You will oversee quality investigations, audits, and performance monitoring while driving strategies to improve outcomes. This role requires deep expertise in HEDIS, CAHPS, and QA leadership, with the ability to influence stakeholders and manage cross-functional teams in a fast-paced health plan environment.

Qualifications

• Bachelor’s degree in Public Health, Health Administration, Business Administration, Nursing, Healthcare Quality, or related field.
• Minimum five years in Quality Improvement/Quality Assurance in healthcare with 3+ years in leadership.
• Experience in fast-paced insurance or healthcare setting.
• Experience in provider relations and education.
• Understanding of quality measures (STARS, HEDIS).

Responsibilities

• Direct HEDIS project deliverables, driving results and improvement by population stream.
• Align Quality and Population Health strategies.
• Provide strategic oversight of Cross-stream Quality Withhold collaborative efforts.
• Direct efforts on maintaining quality documentation including policies/procedures, committee minutes/materials, and program documents.
• Provide oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation.
• Directs efforts on maintaining NCQA and EQRO compliance.
• Maintain confidential information in accordance with policies, and state and federal laws, rules, and regulations regarding confidentiality.
• Oversee the development, implementation and management of quality improvement projects including required contract required Performance Improvement Projects (PIPs) Work collaboratively with OHCA and others to improve health outcomes.
• Oversee HEDIS, CAHPS, and OHCA required measure reporting and evaluation.
• Improve quality measure performance through innovative approaches in engaging members and providers.
• Analyze dashboards consisting of KPI, and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes.
• Incorporate actionable analytics, using 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.
• Use your skills to make an impact

Skills

QI Leadership

Stakeholder Eng

Analytical Skills

HEDIS/CAHPS

Project Management

Communication

Leadership

Quality Measures

Data Analysis

Education

Bachelor's in Public Health

Healthcare Administration

Master's degree (preferred)

Tools

MS Office (Word, Excel, PowerPoint)

Job description

Humana Inc. is seeking a Director, Quality Improvement to lead development, implementation, and evaluation of quality programs across all lines of business.

You will oversee quality investigations, audits, and performance monitoring while driving strategies to improve outcomes. This role requires deep expertise in HEDIS, CAHPS, and QA leadership, with the ability to influence stakeholders and manage cross-functional teams in a fast-paced health plan environment.