Senior Quality Improvement Professional

Profile

Description

The Senior Quality Improvement Professional will focus organizational efforts on improving South Carolina Medicaid clinical quality performance measures to achieve optimal performance and quality for the Humana Healthy Horizons in South Carolina Medicaid Plan. Plans, performs, and implements cross-functional initiatives, analyzes and measures the effectiveness of existing business processes, and develops sustainable, repeatable, and quantifiable quality and process improvements. Works closely with the Quality Improvement Director, 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.

Responsibilities

Humana is an organization with careers that change lives - including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates career that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and posed to make an impact on the future of healthcare, Humana has the right opportunity for you.

Essential Role Functions and Responsibilities

The Senior Quality Improvement Professional is responsible for improving clinical quality improvement and performance improvement metrics for South Carolina Medicaid providers. This includes, but is not limited to:


Develop strategy to improve Performance Measures as identified by the state, including pharmacy measures.
Assess drivers for low performing measures
Develop interventions to improve Performance Measure rates
Assess need for member and provider collateral information (i.e. HEDIS tip sheets, other support pieces - i.e. provider web based training)
Develop collateral documentation needed (based on analysis above)
Work with analyst to develop Performance Measure view for performance measures and identify those practices who potentially need assistance with performance measures (i.e. HEDIS measure analysis)
Leads and participates in QI activities designed to improve performance measures
Collaborate with provider facing teams to drive provider facing QI activities
Develop and submit content in both Member and Provider newsletters to support Performance Measures
SME for all member and provider quality and performance measures content for documents like the Enrollee Newsletter, Provider Manual, and quality documents
Develop and manage a repository of approved provider and member collateral information

Other activities as assigned


Required Qualifications


Bachelor's degree in Business, Healthcare, or related field
3 years of experience working on healthcare quality and performance measure improvement activities (example HEDIS, CAHPS, and health equity)
3 years of previous experience working with providers and provider facing teams on quality and performance improvement activities
Experience performing moderate to complex data analysis
Strong relationship building skills
Excellent written and oral communication skills
Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel
Must be passionate about contributing to an organization focused on continuously improving quality for our members
Ability to work independently under general instructions, must be self-directed and motivated


Workstyle: Remote work at Home

Preferred Location: South Carolina

Alternate Locations: TBD

Schedule: Monday through Friday 8:00 AM - 5:00 PM Eastern Time

Travel: 5% up to two times annually for onsite meetings as needed

Preferred Qualifications


Certified Professional in Healthcare Quality (CPHQ)
Knowledge of QI methodologies/tools including workflows diagrams, root cause analysis
Master's Degree in Public Health
Lean Six Sigma
Advanced degree in business, healthcare, or related field
Current experience working with a complex Medicaid population
Knowledge of Humana's internal policies, procedures and systems
Experience developing provider facing educational materials
Project management experience
Strong business skills, including sales and marketing objectives
Detail orientated and comfortable working with tight deadlines in a fast paced environment
Experience using quality improvement methodology such as plan-do-study-act


Additional Information

Covid Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

Company info

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