Senior Quality Improvement Professional

Employment Type: Full-time

Location Type: Home (Remote, with occasional office use) Work Location: Must reside in Florida Typical Work Days/Hours: Monday – Friday, 8:30 am – 5:00 pm EST

Position Overview

Humana Healthy Horizons in Florida is seeking a Senior Quality Improvement Professional to join the Florida Quality Improvement Department. This role is crucial for collaborating with internal and external customers to complete fast-paced and time-sensitive projects, ensuring the quality of care for members with developmental needs.

Responsibilities

• Reviews progress notes, treatment plans, assessments, and session notes to determine appropriate rendering of Applied Behavioral Analysis (ABA) treatments.
• Researches, gathers information, generates processes, monitors outcomes and trends.
• Develops member and/or provider education and support models and resources based on outcomes in an expedited timeframe.
• Utilizes QI tools and templates to report findings in cross-functional workgroups/subgroups, applying the principles of QI Science.
• Collaborates with internal and external business owners to develop high-quality networks that support members with developmental needs.
• Works independently, sometimes in ambiguous situations, and may perform work with minimal direction.
• Handles additional responsibilities based on business needs.

Required Qualifications

• Bachelor’s degree in social work or a related field, or be a licensed mental health clinician.
• Minimum of two (2) years of experience in Applied Behavioral Analysis (ABA) treatment as a Lead Analyst, as a Board-Certified Assistant Behavior Analyst (BCaBA) under supervision of a BCBA, or as a Registered Behavior Technician under the supervision of a BCBA or BCaBA.
• Experience providing families and children with developmental needs/conditions the services, tools, and supports to achieve optimal quality of life for their child.
• Experience supporting collaborative approaches for care.
• Experience building relationships with members, families, community partners, and providers to support members with developmental needs.
• Demonstrated ability to develop processes, manage projects and deadlines, report outcomes and trends, and develop strategic initiatives.
• Demonstrated ability to develop and deliver member and/or provider education and support models and resources based on outcomes and trends.
• Experience presenting to both internal and external stakeholders with excellent oral and written communication skills.
• Proficiency in manipulating data in Excel.
• Experience using Microsoft Word and PowerPoint to create documents and deliver presentations.

Preferred Qualifications

• Advanced degree in healthcare or a behavioral health-related field.
• Experience with post-payment review to monitor service quality and outcomes for individuals with developmental needs receiving ABA services.
• Experience monitoring outcomes and trends, identifying high-quality providers and appropriateness of services, and reducing complaints.
• Experience enhancing PCP relationships by bringing awareness and insight of monitoring activities related to the appropriateness of services.
• Project Management knowledge and skills.
• Previous Medicaid Managed Care experience.
• Previous quality/medical record review experience.
• Knowledge of Humana's internal policies, procedures, and systems.

Additional Information

Workstyle: Home. This is a remote position, but employees may use Humana office space on an as-needed basis for collaboration and other face-to-face needs.

WAH Internet Statement: To ensure effective work for Home or Hybrid Home/Office employees, the self-provided internet service must meet the following criteria:

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps is recommended.
• Wireless, wired cable, or DSL connection is suggested.
• Satellite, cellular, and microwave connections may be used only if approved by leadership.
• Employees who live and work from home in California must meet specific criteria (details truncated in original text).