Remote Senior Provider Quality Improvement Lead

004 Humana Insurance Company; Wisconsin; Hybrid; USD 86,000 - 119,000; Full time

Benefits offered by this job

Medical insurance

401(k) retirement savings plan

Paid time off

Disability insurance

Life insurance

Job summary

Humana, Inc. is seeking a Provider Quality Improvement Manager to partner across the organization in strengthening provider quality and driving better outcomes. Reporting to the Director of Quality Improvement, you will oversee surveys, audits, incident trends, and regulatory follow-up.

You will lead data-informed decisions and develop the annual quality program. Required are a Bachelor's Degree and extensive experience in quality management and provider relations, with preference for WI

Qualifications

• Bachelor’s Degree required.
• 3+ years of people management experience.
• 5+ years of experience in WI long-term care programs (Family Care or Family Care Partnership).
• 3+ years of experience in Quality Management.
• 1 year of experience in provider relations and education.
• Must reside in WI or in a bordering state.

Responsibilities

• Oversee provider surveys from development through analysis and improvement interventions.
• Audit provider-related activities to ensure policies and processes are followed.
• Manage provider quality referrals to regulatory entities based on complaints or incidents.
• Intake, review, and follow up on statements of deficiencies issued by regulatory entities.
• Collaborate on provider-related activities across the organization to improve processes.
• Analyze and report provider quality metrics and trends to leadership, develop annual quality management program descriptions and work plans.
• Facilitate Quarterly Provider Advisory Committee meetings.
• Monitor and report incident management performance, including trends and risks, driving data-informed decisions.
• Develop and implement corrective actions, prevention strategies, and quality improvement initiatives based on data.

Skills

People management

Quality management

Provider relations

Education

Bachelor's Degree

Job description

Humana, Inc. is seeking a Provider Quality Improvement Manager to partner across the organization in strengthening provider quality and driving better outcomes. Reporting to the Director of Quality Improvement, you will oversee surveys, audits, incident trends, and regulatory follow-up.

You will lead data-informed decisions and develop the annual quality program. Required are a Bachelor's Degree and extensive experience in quality management and provider relations, with preference for WI