[Remote] Senior Quality Improvement Professional at Humana

Michigan, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Bachelor's degree or 5 years related QI experience
Knowledge of QI methodologies (e.g., IHI model of improvement) and QI Tools (e.g., FMEA, KDD, workflows/diagrams, root cause analysis)
Understanding of healthcare quality measures, including HEDIS and STARS ratings
Experience with Medicaid programs
Experience in a fast-paced insurance or healthcare setting
Excellent communication skills, both oral and written
Strong relationship-building skills
Comprehensive knowledge of Microsoft Office, including Word, Excel, and PowerPoint
Must reside in MI or within 40 miles of the border in Indiana or Ohio

Responsibilities

Develop, implement, and evaluate activities of state required PIPs in collaboration with internal and external partners
Understand department, segment, and organizational strategy and operating objectives, including linkages to related areas
Facilitate/participate in quality committees and quality improvement related meetings and discussion with internal and external partners
Develop strategies and interventions to improve Performance Measures identified by the state
Collaborate with member and provider facing teams to drive Quality Improvement (QI) activities
Assess drivers for low performing measures
Monitor and track measures and develop internal strategies for improvement
Work with analysts to develop a Performance Measure view for performance measures and identify improvement opportunities for performance measures (i.e. HEDIS measure analysis)
Lead and participate in QI activities designed to improve performance measures
Make decisions on moderately complex to complex issues regarding technical approach for project components
Ability to work independently under general instructions, must be self-directed and motivated
Exercise considerable latitude in determining objectives and approaches to assignments
Additional responsibilities based on business need
Use your skills to make an impact

Skills

Quality Improvement

Process Improvement

Data Analysis

Performance Measurement

Project Management

Stakeholder Management

Communication

Collaboration

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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