[Remote] Manager, Quality Improvement at Humana

Oklahoma, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

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
Must reside in the state of Oklahoma
Internet download speed of at least 25 Mbps and upload speed of 10 Mbps

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; determines approach, resources, schedules and goals
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, as well as other quality operations, improvement, and compliance functions
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
Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area

Skills

Quality Improvement

Program Management

Data Analysis

Compliance

Auditing

Communication

Stakeholder Management

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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