Quality Improvement Specialist

3 days ago


Madison, Wisconsin, United States Humana Full time

Quality Improvement Professional

Humana is seeking a Quality Improvement Professional to join the Wisconsin Medicaid Market team.

The Quality Improvement Professional monitors incident investigations and compliance processes; manages the incident management system and processes, department SharePoint, and department reporting; audits processes as needed for compliance; 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 applying critical thinking skills to ensure sufficient detail and appropriate follow up and regulatory compliance.

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 as a means to identify and address systemic quality concerns.

Ensure opportunities for stakeholder involvement in activities aimed at supporting quality through the monitoring of incidents and events.

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.
  • Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint.
  • 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.

Work Environment

Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.

Travel

Minimal travel within Wisconsin may be required.

Benefits

We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:

  • Paid time off, holidays, volunteer time and jury duty pay
  • 401(k) retirement savings plan with employer match
  • Tuition assistance
  • Scholarships for eligible dependents
  • Network Resource Groups (NRGs)

Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.



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