Become a part of our caring community and help us put health first
 

The Senior Quality Improvement Professional will focus organizational efforts on improving Michigan Medicaid clinical quality performance measures and Performance Improvement Projects (PIPs) to achieve optimal performance and quality for the Humana Healthy Horizons in Michigan Medicaid Plan. Plans, performs and implements cross functional quality initiatives, analyzes and measure effectiveness, develops sustainable, repeatable and quantifiable quality and process improvement. Works closely with Quality Improvement team and other cross-functional areas 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.

POSITION RESPONSIBILITIES:

• Develop, implement, and evaluate activities of state required PIPs in collaboration with internal and external partners
• Understand department, segment, and organizational strategy and operating objectives, including linkages to related areas
• Facilitate/participate in quality committees and quality improvement related meetings and discussion with internal and external partners
• Develop strategies and interventions to improve Performance Measures identified by the state
• Collaborate with member and provider facing teams to drive Quality Improvement (QI) activities
• Assess drivers for low performing measures
• Monitor and track measures and develop internal strategies for improvement
• Work with analysts to develop a Performance Measure view for performance measures and identify improvement opportunities for performance measures (i.e. HEDIS measure analysis)
• Lead and participate in QI activities designed to improve performance measures
• Make decisions on moderately complex to complex issues regarding technical approach for project components
• Ability to work independently under general instructions, must be self-directed and motivated
• Exercise considerable latitude in determining objectives and approaches to assignments
• Additional responsibilities based on business need

Use your skills to make an impact
 

REQUIRED QUALIFICATIONS:

• Must reside in MI or within 40 miles of the border in Indiana or Ohio
• Bachelor's degree or 5 years related QI experience
• Knowledge of QI methodologies (i.e. IHI model of improvement) and familiarity with QI Tools (i.e. FMEA, KDD, workflows/diagrams, root cause analysis)
• Understanding of healthcare quality measures, including HEDIS and STARS ratings
• Experience with Medicaid programs
• Prior experience in a fast-paced insurance or healthcare setting
• Excellent communication skills, both oral and written
• Strong relationship-building skills
• Comprehensive knowledge of Microsoft Office, including Word, Excel, and PowerPoint

PREFERRED QUALIFICATIONS:

• PMP Certification or Lean Six Sigma program management experience
• Experience in member/provider education and communications
• Certified Professional in Healthcare Quality (CPHQ)
• Proven analytical skills
• Strong organizational skills and ability to manage multiple or competing priorities

Additional Information

WAH Internet Statement

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

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees 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 employees 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.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic