Senior Quality Improvement Professional - Louisville KY or Remote KY

Profile

Description

The Senior Quality Improvement Professional will focus organizational efforts on improving Kentucky Medicaid clinical quality performance measures to achieve optimal performance and quality for the Humana Healthy Horizons in Kentucky Medicaid Plan. Plans, performs, and implements cross-functional initiatives, analyzes and measures the effectiveness of existing business processes, and develops sustainable, repeatable, and quantifiable quality and process improvements. Works closely with the Quality Improvement Director, Quality Improvement Manager and pharmacy leaders to promote an organization-wide culture of quality improvement. The 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 projects and monitors performance metrics for KY Medicaid. Assesses need for and develops collateral materials to support providers, develops processes to share pharmacy and other performance measures with providers. In collaboration with provider facing teams, assists different types of 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. 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 providers. This includes, but is not limited to:

Develops strategy to improve Performance Measures as identified by the state, including pharmacy measures.

Assesses drivers for low performing measures

Develops interventions to improve Performance Measure rates

Assesses need for member and provider collateral information (i.e. HEDIS tip sheets, other support pieces - i.e. provider web based training)

Develops collateral documentation needed (based on analysis above)

Works with analyst to develop Performance Measure view for performance measures and identify those practices who potentially need assistance with performance measures (i.e. HEDIS measure analysis)

Leads and participates in QI activities designed to improve performance measures

Collaborates with provider facing teams to drive provider facing QI activities

Develops and submits content in both Member and Provider newsletters to support Performance Measures

SME for all member and provider quality and performance measures content for documents like the Enrollee Newsletter, Provider Manual, and quality documents

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

Other activities as assigned

Required Qualifications

Active Kentucky licensed clinician including: Pharmacist, Registered Nurse, other licensed healthcare professional

3 years of experience working on healthcare quality and performance measure improvement activities (example HEDIS, CAHPS)

2 years of previous experience working with providers and provider facing teams on quality and performance improvement activities

Experience performing moderate to complex data analysis

Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel

Strong relationship building skills

Excellent written and oral communication skills

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

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

Preferred Qualifications

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

Certified Professional in Healthcare Quality (CPHQ)

Advanced degree in business, healthcare, or related field

Current experience working with a complex Medicaid population

Knowledge of Humana's internal policies, procedures and systems

Experience developing provider facing educational materials

Project management experience

Strong business skills, including sales and marketing objectives

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

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

Additional Information

This person will be located either in the KY office (when going back in after the restrictions are lifted) or within a commutable distance if WAH.

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