[Remote] Manager, Quality Compliance at Humana

Michigan, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor's Degree or 5+ years related work experience in healthcare quality improvement
2 or more years of management/leadership experience
Understanding of healthcare quality measures STARS, HEDIS, etc
Prior experience in a fast-paced insurance or health care setting
Comprehensive knowledge of Microsoft Office suite
Excellent communication skills, both oral and written
Must reside in Michigan or within 40 miles of the border in Indiana or Ohio

Responsibilities

Implement and monitor quality improvement program components, including the annual program description, work plan, and annual evaluation
Drive quality improvement efforts of Humana’s Quality Operations
Support the implementation and monitoring of program documents such as the Quality Improvement Plan, work plan, QAPI committee and evaluation, as well as other quality operations, improvement, and compliance functions
Audit processes as needed for compliance
Complete and submit state, federal, or other reports as required
Collaborate and maintain frequent contact with other managers across departments and health plan
Conduct briefings and area meetings
Determine the plan’s compliance with requirements for NCQA accreditation
Track HEDIS measures along with the assistance of the Quality Data Analyst to ensure the plan meets the goals set for quality measure withholds
Coordinate with relevant internal/external stakeholders, providers, the Michigan Department of Health and Human Services (MDHHS), and other entities to maintain quality operations and improve health outcomes
Make decisions related to resources, approach, and tactical operations for projects and initiatives involving the quality departmental area

Skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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