Become a part of our caring community and help us put health first
The Senior Quality Improvement Professional will focus organizational efforts on improving Michigan Medicaid clinical quality performance measures and Performance Improvement Projects (PIPs) to achieve optimal performance and quality for the Humana Healthy Horizons in Michigan 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:
- Develop, implement, and evaluate activities of state required PIPs in collaboration with internal and external partners
- Understand department, segment, and organizational strategy and operating objectives, including linkages to related areas
- Facilitate/participate in quality committees and quality improvement related meetings and discussion with internal and external partners
- Develop strategies and interventions to improve Performance Measures identified by the state
- Collaborate with member and provider facing teams to drive Quality Improvement (QI) activities
- Assess drivers for low performing measures
- Monitor and track measures and develop internal strategies for improvement
- Work with analysts to develop a Performance Measure view for performance measures and identify improvement opportunities for performance measures (i.e. HEDIS measure analysis)
- Lead and participate in QI activities designed to improve performance measures
- Make 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
- Exercise considerable latitude in determining objectives and approaches to assignments
- Additional responsibilities based on business need
Use your skills to make an impact
REQUIRED QUALIFICATIONS:
- Must reside in MI or within 40 miles of the border in Indiana or Ohio
- Bachelor's degree or 5 years related QI experience
- Knowledge of QI methodologies (i.e. IHI model of improvement) and familiarity with QI Tools (i.e. FMEA, KDD, workflows/diagrams, root cause analysis)
- Understanding 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
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
Additional Information
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 required; 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.
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 year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.
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.