Quality Improvement Specialist

5 days ago

Madison, Wisconsin, United States Humana Full time
Job Summary

We are seeking a highly skilled Quality Improvement Professional to join our team at Humana. The successful candidate will be responsible for monitoring incident investigations and compliance processes, managing the incident management system and processes, and auditing processes as needed for compliance.

Key Responsibilities:

  • Monitor incident investigations and compliance processes
  • Manage the incident management system and processes
  • Audit processes as needed for compliance
  • Complete and submit reports to state regulators as required
  • Implement quality improvement initiatives related to incident management
  • Manage the Incident Management System (IMS) that connects to the state reporting system
  • Review, triage, and process incident reports, quality alerts, and program integrity events
  • Act as a resource to Care Management by providing guidance and education around incident investigation and follow-up
  • Collaborate with Quality Management Leadership and other Departments to ensure appropriate and timely response to immediate member risk or concerns
  • Assist with the collection, organization, and evaluation of data from incidents, events, quality alerts, and statements of deficiency

Requirements:

  • Bachelor's degree or more advanced degree in the human services area (Social work, Sociology, Psychology or Nursing) and a minimum of one year experience working with elders, adults with physical disabilities or adults with intellectual disabilities
  • OR bachelor's degree or more advanced degree in any area other than human services with a minimum of 3 years' experience working with elders, adults with physical disabilities or adults with intellectual disabilities
  • 3 years' experience in a health insurance, health care, or long-term services and support setting
  • Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint

Preferred Qualifications:

  • Experience in WI long-term care programs, Family Care or Family Care Partnership, providing care management support to elders and/or adults with physical or intellectual disabilities
  • Experience in data collection, analysis, and reporting

About Humana:

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.

About Inclusa:

Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity which focuses on the belief in everyone, and from that belief, the common good for all is achieved.

Equal Opportunity Employer:

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status.

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