Senior Quality Improvement Professional

Humana Inc; Virginia (MN); Remote; USD 78,000 - 108,000; Full time

Job summary

An established industry player is seeking a Senior Quality Improvement Professional to enhance healthcare quality performance in Virginia. This role involves implementing quality improvement programs, collaborating with cross-functional teams, and driving initiatives to improve performance measures. The ideal candidate will possess strong analytical skills and experience in healthcare quality measures. Join a forward-thinking organization that prioritizes health and well-being, and make a significant impact in the community through innovative quality improvement strategies.

Qualifications

• Experience with QI methodologies and tools is essential.
• Strong relationship-building skills are crucial for collaboration.

Responsibilities

• Develop and evaluate Performance Improvement Projects in collaboration with partners.
• Lead quality improvement activities to enhance performance measures.

Skills

Quality Improvement methodologies

Healthcare quality measures

Communication skills

Analytical skills

Microsoft Office

Education

Bachelor's degree

5 years related experience

Tools

FMEA

KDD

Root cause analysis

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

The Senior Quality Improvement Professional implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Senior Quality Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Quality Improvement Professional will focus organizational efforts on improving Virginia Medicaid clinical quality performance measures and Performance Improvement Projects (PIPs) to achieve optimal performance and quality for the Humana Healthy Horizons in Virginia Medicaid Plan. Plans, performs and implements cross functional quality initiatives, analyzes and measure effectiveness, develops sustainable, repeatable and quantifiable quality and process improvement. Works closely with Quality Improvement team and other cross-functional areas to promote an organization-wide culture of quality improvement. The Senior Quality Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Position Responsibilities:

• Develops, implements, and evaluates activities of state required Performance Improvement Projects (PIPs) in collaboration with internal and external partners.
• Understands department, segment, and organizational strategy and operating objectives, including linkages to related areas.
• Facilitates/participates in quality committees and quality improvement related meetings and discussion with internal and external partners
• Develops strategies and interventions to improve Performance Measures identified by the state.
• Collaborates with member and provider facing teams to drive QI activities
• Assesses drivers for low performing measures
• Monitors and tracks measures and develops internal strategies for improvement.
• Works with analyst to develop Performance Measure view for performance measures and identify improvement opportunities for performance measures (i.e. HEDIS measure analysis).
• Leads and participates in QI activities designed to improve performance measures.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components.
• Ability to work independently under general instructions, must be self-directed and motivated.
• Exercises considerable latitude in determining objectives and approaches to assignments.

Use your skills to make an impact

Required Qualifications:

• Bachelor's degree or 5 years related Quality Improvement experience
• 1+ year experience with working QI methodologies (i.e. IHI model of improvement) and familiarity with QI Tools (i.e. FMEA, KDD, workflows/diagrams, root cause analysis)
• 2+ years’ experience of healthcare quality measures, including HEDIS and STARS ratings
• Experience with Medicaid programs
• Prior experience in a fast-paced insurance or healthcare setting
• Excellent communication skills, both oral and written
• Strong relationship-building skills
• Comprehensive knowledge of Microsoft Office, including Word, Excel, and PowerPoint
• Must reside and perform work in the state of Virginia
• May attend meetings in the Richmond, VA office as needed for business needs

Preferred Qualifications:

• PMP Certification or Lean Six Sigma program management experience
• Experience in member/provider education and communications
• Certified Professional in Healthcare Quality (CPHQ)
• Proven analytical skills
• Strong organizational skills and ability to manage multiple or competing priorities

Work-At-Home Requirements

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 required.
• 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.

Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a SMS Text Messaging interview.(please be sure to check your spam or junk folders often to ensure communication isn’t missed)

The SMS Text interview, will ask you a series of questions to which you will be using your Cell phone OR Email to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

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.