Quality Improvement Lead

Profile

Description

The Quality Improvement Lead implements performance improvement projects, interventions and programs for Ohio Medicaid business including collaborative health plan quality improvement performance projects, activities and monitors performance and metrics for Ohio Medicaid populations. . The Quality The Quality Improvement Lead implements performance improvement projects, interventions and programs for Ohio Medicaid business including collaborative health plan and Ohio Department of Medicaid quality improvement performance projects, activities, and interventions. This position is responsible for monitoring performance improvement and metrics for Ohio Medicaid populations. The Quality Improvement Lead works independently, sometimes in ambiguous situations, and work may be performed with minimal direction. The Quality Improvement Lead will be expected to lead a team in order to execute the QI strategy. This position makes decisions on moderately complex to complex issues regarding the technical approach for project components, and work may be performed without specific direction. The position exercises considerable latitude in determining objectives and approaches to assignments, with work that influences the Ohio Medicaid strategy.

Responsibilities

The Quality Improvement Lead completes and submits reports to executive leadership, collaborative entities (internal and/or external) and state regulators as required for clinical studies. Develops functional strategies on matters of significance and advises executives. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.

Additional Responsibilities will Include:

Implements quality programs

Completes thorough analysis of data and implements improvement cycles

Requires a solid understanding of how organization capabilities interrelate across department(s). Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving inter-departmental areas.

Requires cross function, departmental and managed care collaboration and conducts briefings and area meetings; maintains frequent contact with other managers and stakeholders across departments.

Additional responsibilities as determined by contract and business needs

Required Qualifications

5 years of quality improvement experience in a health related field

2 years of project leadership experience

Prior experience working with quality projects in a fast-paced insurance or health care setting

Experience with Medicaid membership and/or programs

Experience with quality improvement science, tools, and collaborative project teams

Demonstrated management experience and ability to partner with senior leadership on strategic initiatives

Strong Clinical Quality experience

Ability to manage multiple projects and meet deadlines using IHI (Institute for Healthcare Improvement) principals or other equivalent methodologies (ie: Lean, Six Sigma etc)

Comprehensive knowledge of the Microsoft Suite of applications

Proven analytical skills

Excellent communication skills, both oral and written

Strong relationship building skills

Ability to travel - up to 20% within the state of Ohio

Preferred Qualifications

Associates Degree or higher

CPHQ Certification

Lean Six Sigma Certification

Project management skills

Knowledge of Humana's internal policies, procedures and systems

Experience working with healthcare members and providers within a managed care setting

Additional Information

This position is open to working remote in Ohio with ability to travel to Humana office in Dublin.

Home Internet Standards

All Humana associates approved for the Home or Hybrid Home/Office work styles are required to self-provide wireless, wired cable or DSL access to the internet at the connectivity speeds required by the company to successfully perform their job with the exception of associates who live or work from home in the state of California, Illinois, Montana, or South Dakota. Connectivity requirements are detailed below.

Connectivity - Requirement Details

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

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.

Wireless, Wired Cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)

Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates 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 associates with telephone equipment appropriate to meet the business requirements for their position/job.

Covid Policy

Humana 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.

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Scheduled Weekly Hours

40

Humana 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=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com