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Humana Healthy Horizons is seeking a Quality Improvement Program Lead who will be responsible for the end to end ownership of Humana Healthy Horizon's National Quality Improvement (QI) efforts, capability advancement activities, and the development and maintenance of QI frameworks and toolkits to support Quality associates throughout the line of business. The Quality Improvement Program Lead reports directly to the National Medicaid Quality Director.

The Quality Improvement Program Lead exercises independent judgment and decision making on complex issues within their scope, works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.

Responsibilities include:

• Provides direction and oversight of Humana’s QI programs management model and improvement strategy for the Medicaid line of business at the national level.
• Develops policy and procedure, and defines/improves processes regarding quality measurement data collection and improvement methodology for all initiatives impacting Medicaid beneficiaries.
• Develops and maintains QI methodology play books and tool kits to support market QI efforts.
• Serves as the lead of the Quality related functions related to NCQA’s Health Equity Accreditation.
• Oversees related work plan development and evaluation of programs across all Medicaid markets.
• Nurtures relationships with national and market partners to expand and strengthen quality improvement efforts. 
• Ensures organizational awareness of key developments and leads in identification and development of national quality interventions.
• Drives interdepartmental collaboration to achieve business goals.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree
• 3+ years of experience managing Healthcare Quality programs OR 8+ years of quality improvement experience.
• 5+ years of experience monitoring and improving quality measures (example HEDIS or CAHPS) in a quality improvement / quality management or office-based practice setting.
• Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel.
• Demonstrated ability to perform moderate to complex data analysis.
• Strong relationship building skills.
• Excellent written and oral communication skills.
• Ability to work independently under general instructions, must be self-directed and motivated.

Preferred Qualifications.

• Certified Professional in Healthcare Quality (CPHQ)
• Experience with quality improvement methodology, preferably with the IHI Model for Improvement. Lean/Six Sigma, or other standardized methodology.
• Experience with SharePoint design.
• Advanced degree in business, healthcare, or related field.
• Project management experience.
• Strong business acumen.

Work-At-Home Requirements

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; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information

• Training: Virtual in your home office
• Travel: up to 10%
• Work Hours: Eastern Standard Time (EST)

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to