Senior Quality Improvement Professional

Humana Inc; Orlando (FL); Remote; USD 78,000 - 108,000; Full time

Job summary

A leading company in healthcare is seeking a Senior Quality Improvement Professional to drive quality initiatives within the Florida Department. You will review treatment plans, develop educational resources, and collaborate with various stakeholders to ensure optimal service delivery. This role requires a strong background in Applied Behavioral Analysis and the ability to work independently in a dynamic environment.

Qualifications

• Minimum of two years experience in Applied Behavioral Analysis (ABA) treatment.
• Demonstrated ability in developing member and/or provider education and support models.
• Experience building relationships with families and community partners.

Responsibilities

• Reviews progress notes and treatment plans for ABA appropriateness.
• Develops educational resources based on outcomes.
• Collaborates with business owners to enhance quality networks.

Skills

Communication

Project Management

Data Analysis

Education

Bachelor's degree in social work or a related field

Tools

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Job description

Job Profile

Senior Quality Improvement Professional

Job Level

Senior Professional

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

Humana Healthy Horizons in Florida is seeking a Senior Quality Improvement Professional who will be an integral part of the Florida Quality Improvement Department. This role will collaborate with internal and external customers to complete fast paced and time sensitive projects.

The Senior Quality Improvement Professional:

• Reviews progress notes, treatment plans, assessments, and session notes to determine if Applied Behavioral Analysis treatments are being rendered appropriately.
• Researches, gathers information, generates processes, monitors outcomes and trends.
• Develops member and/or provider education and support models and resources based on outcomes in an expedited timeframe.
• Uses QI tools and templates to report out in cross-functional workgroups/subgroups using the tenants of QI Science.
• Collaborates with internal and external business owners to develop high quality networks which support members with developmental needs.
• Works independently, sometimes in ambiguous situations, and work may be performed with minimal direction.
• Has additional responsibilities based on business needs.

Use your skills to make an impact

Required Qualifications

• Bachelor’s degree in social work or a related-field or be a licensed mental health clinician.
• Minimum of two (2) years of experience in Applied Behavioral Analysis (ABA) treatment as a Lead Analyst, as a Board-Certified Assistant Behavior Analyst under supervision of BCBA, or as a Registered Behavior Technician under the supervision of BCBA or BCaBA.
• Experience providing families and children with developmental needs/conditions, the services, tools, and supports to achieve optimal quality of life for their child and supporting collaborative approaches for care.
• Experience building relationships with members, families, community partners and providers to support members with developmental needs.
• Demonstrated ability to develop processes, manage projects and deadlines, report outcomes and trends, and develop strategic initiatives.
• Demonstrated ability to develop and deliver member and/or provider education and support models and resources based on outcomes and trends.
• Experience giving presentations to both internal and external stakeholders with excellent oral and written communication skills.
• Ability to manipulate data in Excel and experience using Microsoft Word and PowerPoint to create documents and deliver presentations.

Preferred Qualifications

• Advanced degree in healthcare or a behavioral health related field.
• Experience with post payment review to monitor service quality and outcomes for individuals with developmental needs receiving ABA services.
• Experience monitoring outcomes and trends, identifying high quality providers and appropriateness of services; reducing complaints.
• Experience enhancing PCP relationships by bringing awareness and insight of monitoring activities related to the appropriateness of services.
• Project Management knowledge and skills.
• Previous Medicaid Managed Care experience.
• Previous quality/medical record review experience.
• Knowledge of Humana's internal policies, procedures and systems.

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: must reside in Florida.
• Typical work days/hours: Monday – Friday, 8:30 am – 5:00 pm EST.

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 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.

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.

Limited Geography Remote - This is a remote position but located within a specific geography.

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.$78,400 - $107,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Referral Bonus Information

This requisition is not eligible for a referral bonus.

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 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.