Senior Quality Improvement Professional - Behavioral Health - Remote Kentucky

Profile

Description

The Senior Quality Improvement Professional will focus organizational efforts on improving behavioral health (BH)/Substance Use Disorder (SUD) clinical quality performance measures to achieve optimal performance and quality for the Humana Healthy Horizons in Kentucky Medicaid Plan. They will plan, perform, and implement cross-functional initiatives, analyze and measure the effectiveness of existing initiatives, and develop sustainable, repeatable, and quantifiable behavioral health process improvements. They will work closely with the Quality Director, Behavioral Health Director, Quality Improvement Manager and those targeting specialized behavioral health services to promote an organization-wide culture of quality improvement. Senior Quality Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Responsibilities

The Senior Quality Improvement Professional uses data to develop and lead quality improvement activities and monitor performance metrics for KY Medicaid. The Senior Quality Improvement Professional assesses the need for and develops collateral materials to support BH/SUD (behavioral health (BH)/Substance Use Disorder (SUD)) providers, develops processes to share BH/SUD performance measures with providers, and assists BH/SUD practices to achieve performance and quality improvement goals. The Senior Quality Improvement Professional chairs and participates in multidisciplinary committees (internal and external) to promote quality care for Kentucky Medicaid enrollees receiving behavioral health services. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. The Senior Quality Improvement Professional works independently sometimes in ambiguous situations, and work is performed with minimal direction. Exercises considerable latitude in determining objectives and approaches to assignments. Work influences department strategy.

The Senior Quality Improvement Professional is responsible for improving clinical quality improvement and performance improvement metrics for Kentucky Medicaid behavioral health providers. This includes, but is not limited to:

Assesses need for collateral information (i.e. HEDIS tip sheets, other BH support pieces - i.e. Transitional Case Management documentation)

Develops collateral documentation needed (based on analysis above)

Develops relationships with BH/SUD Providers: Goal to provide education and improve overall performance

Provides Performance Measures and other quality related information / education to BH/SUD providers

Works with analysts to develop Performance Measure view for BH/SUD providers and identify those practices who potentially need assistance with BH performance measures (i.e. HEDIS measure analysis) Participate in QI activities designed to improve BH / SUD measures, drive provider facing Quality Improvement activities

Collaborates with internal teams (both market and Corporate based) such as BH clinical teams and provider relations to meet business objectives

Provides education directly to providers as related to medical record documentation review

Develops and submits content in both Member and Provider newsletters to support Quality and Performance Measure improvement

SME for all member and provider BH content for documents such as the Enrollee Newsletter, Provider Manual, and quality documents

Develops and manages a repository of approved provider and member collateral information

Other activities as assigned

Must be able to travel to provider practices in either the eastern or the western half of the state.

Travel up to 50% of the time (within Kentucky) to meet with and support BH/SUD providers.

Required Qualifications

Active Kentucky licensed clinician including: Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPCC), Registered Nurse with behavioral health experience

3 years of current experience working with a complex behavioral health Medicaid population and knowledge of various types of behavioral health service criteria, specifically Kentucky Medicaid behavioral health requirements

2 years of experience monitoring and improving behavioral health quality measures (example HEDIS or CAHPS) in a quality operations / quality management or office based practice setting

Previous experience working with behavioral health providers on quality and performance improvement activities

Demonstrated ability to perform moderate to complex data analysis

Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel

Strong relationship building skills

Excellent written and oral communication skills

Must be passionate about contributing to an organization focused on continuously improving quality for our members

Ability to work independently under general instructions, must be self-directed and motivated

Preferred Qualifications

Bachelor's degree in Business, Healthcare, or related field

Certified Professional in Healthcare Quality (CPHQ)

Experience with quality improvement methodology such as plan-do-study-act

Advanced degree in business, healthcare, or related field

Project management experience

Strong business skills, including sales and marketing objectives

Previous experience developing provider facing educational materials

Detail orientated and comfortable working with tight deadlines in a fast paced environment

Additional Information

Must be able to travel to provider practices in either the eastern or the western half of the state.

Travel up to 50% of the time (within Kentucky) to meet with and support BH/SUD providers.

Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m (satellite and/or wireless internet connections are NOT permitted for Work at Home roles) and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process. #ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40

Company info

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