Location
Dover, DE, United States
Posted on
Mar 05, 2021
Profile
Description
Humana's National Medicaid Quality team is seeking a Market Consultant to be responsible for supporting individual Medicaid market quality teams and serving as the main relationship broker and liaison to the corporate level National Medicaid Quality team and other corporate quality resources and shared service organizations. This individual will interact with multiple business areas to ensure the success of their market partners by supporting the transition from implementation to operation, solving new market specific challenges, assuring the market's interest are accounted for in all national Medicaid quality programs and projects, and providing ongoing guidance and support of the market's quality improvement (QI) strategy and execution.
Responsibilities
Role Responsibilities:
Serve as main corporate level point of contact for all Medicaid quality related issues for assigned market
Function as an extended member of the market quality team, and sole relationship broker between market and corporate quality personnel.
Work closely with the market QI director on a frequent basis.
Support and guide all efforts to improve member health outcomes within the market, HEDIS and CAHPS scores, and the operational efficiency of the market quality program.
Ensure that the market quality team has adequate access to any necessary corporate level tools and resources, and act as an advocate for market interests within corporate level activities.
Support national Medicaid quality efforts by owning and/or assisting with national level projects as needed.
Lead or assist in individual projects around the development of new national capabilities and programs such as training development, QI initiative strategy and execution, data and reporting development, etc.
Display strong knowledge and expertise within the realm of Healthcare Quality operations and improvement methodology, HEDIS/CAHPS and other forms of Quality measurement, and the improvement of clinical outcomes within Medicaid and Dual Eligible populations.
The Medicaid Quality Market Consultant will be expected to function as a subject matter expert in healthcare quality measurement, best practices, and standards defined by national organizations such as the National Committee for Quality Assurance (NCQA), the Agency for Healthcare Research and Quality (AHRQ), and the National Association for Healthcare Quality (NAHQ). This will require developing a full understanding of existing and new concepts, contracts, policies, and business relationships at a very rapid pace.
The successful candidate will be expected to efficiently navigate Humana's organizational structure and operating models at a very rapid pace, and in a manner that is often self-guided.
Given the daily interaction with dozens of business areas throughout Humana, the candidate must be very comfortable operating in a complex matrix environment, able to learn and understand the larger organizational structures quickly, and be comfortable and confident interacting with associates ranging from entry level to senior leadership.
Must be self-motivated and able to thrive in navigating new business needs with limited guidance , as many challenges will be first time problems or newly identified gaps with no existing solution or answer.
This role will be required to report-out progress and success measurement for projects and work streams to various levels of leadership. Strong written and oral communication and professional presentation skills will be a necessity.
Required Qualifications:
Bachelor's Degree
5 equivalent years of experience in Medicaid Quality Assurance or Improvement
Project Management experience
Proficiency in Microsoft Office applications (Word, Excel, Visio, PowerPoint, Teams, Project, etc.)
Superb communication skills, written and verbal
Proficiency in interpreting broad organizational goals, contract language, and data trends, and applying toward process development and improvement methodologies
Strong organizational and matrix management skills
Effective facilitator - direct collaborative efforts amongst internal and external partners
Extremely self-sufficient, not overly reliant on guidance or direction to complete tasks.
Must be comfortable communicating results to Senior Level leadership
Work shift will be in Eastern Time Zone
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) is required.
A dedicated home office space, with a locked door, lacking ongoing interruptions to protect member PHI / HIPAA information
Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test
Preferred Qualifications:
Masters level degree in Public Health or Business Administration
Previous clinical experience (nursing, therapy, social work, etc.)
CPHQ certification
PMP certification or 3 year Project Management experience is a plus
Additional Information
The following policy applies ONLY to associates working in the state of Arizona :
Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.
Scheduled Weekly Hours
40
Company info
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