01 Nov
Senior Quality Improvement Professional
Ohio, Cincinnati , 45201 Cincinnati USA

DescriptionThe Senior Quality Improvement Professional will focus organizational efforts on improving South Carolina Medicaid clinical quality performance measures to achieve optimal performance and quality for the Humana Healthy Horizons in South Carolina Medicaid Plan. Plans, performs, and implements cross-functional initiatives, analyzes and measures the effectiveness of existing business processes, and develops sustainable, repeatable, and quantifiable quality and process improvements. Works closely with the Quality Improvement Director, Quality Improvement team and other cross-functional areas to promote an organization-wide culture of quality improvement. The Senior Quality Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.ResponsibilitiesHumana is an organization with careers that change lives - including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates career that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and posed to make an impact on the future of healthcare, Humana has the right opportunity for you.Essential Role Functions and ResponsibilitiesThe Senior Quality Improvement Professional is responsible for improving clinical quality improvement and performance improvement metrics for South Carolina Medicaid providers. This includes, but is not limited to:Develop strategy to improve Performance Measures as identified by the state, including pharmacy measures.

Assess drivers for low performing measures

Develop interventions to improve Performance Measure rates

Assess need for member and provider collateral information (i.e. HEDIS tip sheets, other support pieces - i.e. provider web based training)

Develop collateral documentation needed (based on analysis above)

Work with analyst to develop Performance Measure view for performance measures and identify those practices who potentially need assistance with performance measures (i.e. HEDIS measure analysis)

Leads and participates in QI activities designed to improve performance measures

Collaborate with provider facing teams to drive provider facing QI activities

Develop and submit content in both Member and Provider newsletters to support Performance Measures

SME for all member and provider quality and performance measures content for documents like the Enrollee Newsletter, Provider Manual, and quality documents

Develop and manage a repository of approved provider and member collateral information

Other activities as assigned

Required QualificationsBachelor's degree in Business, Healthcare, or related field

3+ years of experience working on healthcare quality and performance measure improvement activities (example HEDIS, CAHPS, and health equity)

3+ years of previous experience working with providers and provider facing teams on quality and performance improvement activities

Experience performing moderate to complex data analysis

Strong relationship building skills

Excellent written and oral communication skills

Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel

Must be passionate about contributing to an organization focused on continuously improving quality for our members

Ability to work independently under general instructions, must be self-directed and motivated

Workstyle: Remote work at HomePreferred Location: South CarolinaAlternate Locations: TBDSchedule: Monday through Friday 8:00 AM - 5:00 PM Eastern TimeTravel: 5% up to two times annually for onsite meetings as neededPreferred QualificationsCertified Professional in Healthcare Quality (CPHQ)

Knowledge of QI methodologies/tools including workflows diagrams, root cause analysis

Master's Degree in Public Health

Lean Six Sigma

Advanced degree in business, healthcare, or related field

Current experience working with a complex Medicaid population

Knowledge of Humana's internal policies, procedures and systems

Experience developing provider facing educational materials

Project management experience

Strong business skills, including sales and marketing objectives

Detail orientated and comfortable working with tight deadlines in a fast paced environment

Experience using quality improvement methodology such as plan-do-study-act

Additional InformationCovid PolicyHumana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.Scheduled Weekly Hours40Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.

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