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

Humana is seeking a Quality Improvement Professional to join the Wisconsin Medicaid Market team. The Quality Improvement (QI) Professional performs duties to support optimized performance on quality indicators and initiatives across all lines of business. The QI professional fosters a culture of quality improvement in collaboration with appropriate teams that directly impact members by ensuring data accuracy in reporting, investigation, auditing, compliance, and improvement opportunities.

• Assist in the collection, organization, and evaluation of Quality Assessment Performance Improvement (QAPI) program data from multiple sources for all lines of business to support the quality management program and assist in the development of annual quality program documents (program description, workplan, and evaluation).
• Use continuous quality improvement process through tracking and trending data including clinical analysis and reporting for quality monitoring and improvement. 
• Collaborate with Quality Management Leadership and other departments to ensure risks are mitigated and concerns are addressed related to quality management activities and findings.
• Participate in quality improvement activities that span multiple lines of business.
• Audit processes as needed for compliance.
• Complete and submit reports to CMS, state regulators, and enterprise.
• Understand department, market, lines of business, and organizational strategy and operating objectives.
• Lead or participate in initiatives to further quality related organizational objectives.
• Organize and lead Market NCQA related activities in collaboration with other Departments and enterprise partners.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree.
• 3 years of experience in a health insurance, health care setting or long-term services or supports program.
• Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.
• Experience in data collection, analysis, and reporting.
• Experience in leading quality or healthcare related initiatives from inception to completion.

Preferred Qualifications

• Knowledge of NCQA accreditation process and standards.
• 3 years of experience in any of the following WI Medicaid Programs: Family Care, Family Care Partnership, BadgerCare Plus, SSI managed care.
• 3 years of experience in quality management.

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.  
• Travel: minimal travel to WI may be required for in person meetings.
• Typical Work days/hours: Monday – Friday, 8:00 am – 5:00 pm Central Standard Time (CST)

WAH Internet Requirements

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 recommended; 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.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

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