Manager, Quality Improvement

The Manager, Quality Improvement implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Manager, Quality Improvement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. QI Manager plays a key role on the NCQA Health Plan accreditation and reaccreditation process.

The Manager, Quality Improvement ensures the Quality Assessment and Performance Improvement (QAPI) program for Humana Healthy Horizons in Oklahoma operates effectively.

Drives quality improvement efforts of Humana's Quality Operations.

Supports the implementation and monitoring of program documents such as the program description, work plan, QAPI committee and evaluation, as well as other quality operations, improvement, and compliance functions.

Audits processes as needed for compliance.

Completes and submits state or federal reports as required.

Collaborates and maintains frequent contact with other managers across departments and health plan.

Conducts briefings and area meetings.

Determines the plan's compliance with requirements for NCQA accreditation.

Tracks HEDIS measures along with the assistance of the Quality Data Analyst to ensure the plan meets the goals set for quality measure withholds.

Coordinates with relevant internal/external stakeholders, providers, state department of health and other entities to maintain quality operations and improve health outcomes.

Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.

Required Qualifications

• Must reside in the state of Oklahoma
• Bachelor's degree required
• 2+ years of management or leadership experience
• 2+ years of experience in a fast-paced insurance or healthcare setting
• Familiarity with Quality Improvement tools and methodologies (e.g., PDSA, root cause analysis, IHI Model for Improvement, etc.)
• Understanding of healthcare quality measures such as HEDIS, STARS, etc.
• Demonstrated ability tobuild and maintain strong professional relationships
• Proficient in Microsoft Office Suite, including Word, Excel, and PowerPoint
• Strong analytical and problem-solving skills
• Excellent verbal and written communication skills

Preferred Qualifications

• Experience working with Performance Improvement Projects (PIPs)
• CPHQ (Certified Professional in Healthcare Quality)
• Prior experience with Medicaid programs

Additional Information

• Schedule: Monday through Friday, 8:00 AM – 5:00 PM, with flexibility to work overtime as needed
• Location: Must reside in the state of Oklahoma
• Work Style: Hybrid or remote (Oklahoma residents only)

Work-at-Home (WAH) Internet Statement

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$86,300 - $118,700 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, 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.

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.