Senior Quality Improvement Professional

Ohio, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must reside in the EST or CST time zone and possess a Bachelor's degree or 5 years of related Quality Improvement experience. Prior experience in a fast-paced health insurance or health care setting, understanding of healthcare quality measures (HEDIS, STARS, CMS, etc.), and comprehensive knowledge of Microsoft Office Suite are required. The ability to present information across different organizational levels and work both independently and collaboratively is also necessary. Preferred qualifications include residing in Ohio, knowledge of QI methodologies and tools, CPHQ or Lean Six Sigma certification, strong analytical skills, and excellent communication abilities.

Responsibilities

The Senior Quality Improvement Professional will support Quality Improvement functions for the Ohio Medicaid plan, working on moderately complex to complex assignments and projects. This role involves leading projects related to Quality Withhold, vendor management, internal and external audits, and the Quality Improvement Committee. The professional will need to work independently, manage multiple projects simultaneously, and collaborate effectively within a highly matrixed organization. They will also be responsible for occasional overtime or weekend work as business needs require.

Skills

Quality Improvement

HEDIS

STARS

CMS

Microsoft Office Suite

Excel

Word

QI methodologies

IHI model of improvement

QI Tools

FMEA

KDD

workflows

diagrams

root cause analysis

CPHQ

Lean Six Sigma

analytical skills

communication skills

member education

provider education

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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