Quality Improvement Lead
Included HealthFull Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
Candidates must possess a Bachelor's degree in Business, Finance, Health Care/Administration, RN, or a related field, or equivalent work experience. Required qualifications include experience with Medicare and/or managed care, a strong understanding of the NCQA and CMS Stars Rating System (including HEDIS measures, PQA Measures, and CAHPS/HOS survey system), knowledge of clinical utilization and performance improvement levers, and the ability to drive interoperability. Experience in building relationships and understanding consumer/patient experience is also necessary.
The Senior Network Performance Professional will collaborate with providers to define and advance goals in interoperability, quality, value-based arrangements, and risk adjustment strategies, recommending and monitoring execution plans. They will serve as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience, and developing tailored action plans. Responsibilities include resolving provider abrasion issues to maintain positive relationships, partnering with internal teams to track and report market performance, and analyzing provider data to identify and implement performance improvement strategies. Additionally, they will act as a liaison for providers to access Humana resources, educate provider groups on reward programs and target metrics, and monitor the effectiveness of these programs.
Health insurance provider for seniors and military
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.