Hybrid Manager, Quality Improvement

at Humana

• Job title: Manager, Quality Improvement
• Job type: Full Time
• Experience level: Junior, Mid level
• Salary: $86,300 - $118,700 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, United States

About the role

• Manager of Quality Improvement implementing quality improvement programs for Humana. Driving quality improvement efforts and ensuring compliance with NCQA Health Plan accreditation in Oklahoma.

Responsibilities

• implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation
• works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems
• plays a key role on the NCQA Health Plan accreditation and reaccreditation process
• ensures the Quality Assessment and Performance Improvement (QAPI) program for Humana Healthy Horizons in Oklahoma operates effectively
• drives quality improvement efforts of Humana’s Quality Operations
• supports the implementation and monitoring of program documents such as the program description, work plan, QAPI committee and evaluation
• audits processes as needed for compliance
• completes and submits state or federal reports as required
• collaborates and maintains frequent contact with other managers across departments and health plan
• conducts briefings and area meetings
• determines the plan’s compliance with requirements for NCQA accreditation
• tracks HEDIS measures along with the assistance of the Quality Data Analyst to ensure the plan meets the goals set for quality measure withholds
• coordinates with relevant internal/external stakeholders, providers, state department of health and other entities to maintain quality operations and improve health outcomes

Requirements

• Must reside in the state of Oklahoma
• Bachelor's degree required
• 2+ years of management or leadership experience
• 2+ years of experience in a fast-paced insurance or healthcare setting
• Familiarity with Quality Improvement tools and methodologies (e.g., PDSA, root cause analysis, IHI Model for Improvement, etc.)
• Understanding of healthcare quality measures such as HEDIS, STARS, etc.
• Demonstrated ability to build and maintain strong professional relationships
• Proficient in Microsoft Office Suite, including Word, Excel, and PowerPoint
• Strong analytical and problem-solving skills
• Excellent verbal and written communication skills

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance and many other opportunities