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Associate VP Quality Improvement

3 months ago

Chicago, Illinois, United States CLevelCrossing Full time
Job Information
Humana
Associate VP, Quality Improvement
in
Chicago
Illinois
Description

The AVP, Quality Improvement and Performance will develop, maintain, own and execute strategies to improve performance of the TRICARE contract and maintain performance under HGB's Clinical Quality Management Program.

This individual is accountable for the overall quality performance across all care services products including HEDIS, Quality, value-based care, and outcome-based strategies.

Responsibilities

Location:
Remote Open to U.S.

Summary:


This is a highly cross-functional position, working with Clinical Operations, Market Operations, Network, Beneficiary Experience, IT, Service Operations, and the Trend and Innovation Teams to understand opportunities for improved quality and to implement evidenced based interventions.

This role will collaborate with multiple stakeholders across HGB, as well as across the Enterprise to ensure best practice and learnings are incorporated from across Humana.

This role will use data to identify root causes in low quality performance and will facilitate creative problem solving from across the organization to help understand what beneficiaries need to receive better care.

This will involve a Population Health lens - all while keeping the beneficiary at the center.

Primary Responsibilities:
Ownership of overall end to end TRICARE Quality Strategy, including execution and results of new programs in a highly cross-functional environment
Collaboration with regional and local plan business leaders to improve quality scores and meet contractual obligations of quality requirements
Facilitate highly cross functional problem-solving spaces to find creative strategies to impact quality - keeping the beneficiary at the center to ensure solutions will have a positive impact/address root causes
Understand and utilize learnings from Enterprise and incorporate them into HGB operations
Ensure program compliance and identifies opportunities to improve service and quality outcomes
Oversees the development and execution of quality/HEDIS program management policies, procedures, and guidelines; assists in developing clinical management guidelines and value based contracting standards
Utilize project management and intervention skills to evaluate all quality initiatives, track progress and adjust strategy to achieve agreed upon targeted coals
Serves as a quality change agent, and subject matter expert for internal and external stakeholders, including the federal government
Take ownership of quality analytics capabilities - collaborating with Trend and Analytics for reporting of core metrics around HEDIS, experience, and care delivery
Aligns resources across diverse areas such as member services, care management, population health, network, and data/analytics, and IT
Keeps senior staff apprised of opportunities and current performance standards and identifies risks and mitigation strategies to achieving performance goals

Develops new and innovative best practices around critical contractual areas such as Alternative Payment Models (APMs) and delivery system reform.

Develops provider and member driven strategies to close gaps in care and engage with the care system to decrease cost, increase quality, and direct appropriate utilization.

Guide the organization to a continuous quality driven mindset utilizing standardized tools such as, lean, six sigma, PDSA, and total quality management principles
Required Qualifications
5 years of experience in Quality Improvement/Quality Assurance in the healthcare field.
4 years of management experience leading diverse teams around analytics, operations, and project management
4 years of experience working directly with quality reporting requirements such as HEDIS, CAHPS, Medicare, Medicaid, and Commercial contracts
2 years of experience managing/implementing clinical programs and teams
Clinical program development and implementation experience.
Strong understanding of NCQA Health Plan accreditation standards and requirements.

Demonstrated skills in quality improvement concepts, health care data analysis, data mining methods and the identification of population health issues, trends, and health disparities using health care data sources.

Understanding of value based payment models that reward quality improvement.
Understanding of cultural factors that influence health outcomes and implementing culturally competent responsive improvement interventions.
Experience implementing rapid-cycle improvement techniques that demonstrated material improvements.
Excellent communication skills and experience in cross-functional collaboration in matrixed organizations.
Minimum of a bachelor's degree
Department of Defense contract requires U.S. citizenship for this position
Successfully receive interim approval for government security clearance (eQIP - electronic questionnaire for investigation processing)
Preferred Qualifications
Advanced degree (Masters, Doctoral, MD/DO, Six Sigma/lean certifications, in nursing, public health, health administration, health policy or business)
Certified Professional in Health Care Quality (CPHQ) by the National Association of HealthCare Quality (NAHQ) or
a Certified in HealthCare Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers.
Understanding of TRICARE and knowledge of DHA preferred
Understanding of T5 TRICARE contract requirements for Quality measures, preferred
Additional Information

For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work.

The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home.

We are ahealthcarecompany committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:
Provide proof of full vaccination, including boosteror commit to testing protocols
*OR*Provide proof of applicable exemption including any required supporting documentation
Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours
40

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