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The Director, Quality Improvement implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Director, Quality Improvement requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

               

The Director, Quality Improvement provides leadership for our Indiana Pathways Quality Program, in alignment with organizational quality and population health goals and ensuring compliance with the Indiana Contract, as well as local, state, and federal requirements.  He/she will be responsible for: 

• Directing the activities of the quality management staff in monitoring and auditing the health care delivery system, including, but not limited to, internal processes and procedures, provider network(s), service quality and clinical quality.
• Ensuring a Quality Management infrastructure that promotes member safety, quality of care, reduces disparities, and promotes access to care in the least restrictive setting.
• Responsible for developing, implementing, and monitoring the quality assurance and performance improvement program for quality improvement interventions.  
• Support NCQA accreditation and have oversight of quality investigations and compliance processes, including quality of care concerns.
• Oversees the development, implementation and management of quality improvement projects and work collaboratively to address health equity and social determinants of health 
• Assist the Indiana Pathways Compliance Officer in overseeing the activities of operations to meet the State’s goal of providing health care services that improve the health status and health outcomes of members.
• Oversees HEDIS, CAHPS, and FSSA required measure reporting and evaluation.  
• Ensures compliance with quality-of-care investigations and reporting. 
• Provides oversight of the Annual Quality Program Descriptions, Work Plans, and Program Evaluations 
• Analyzes dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes. 
• Incorporates actionable analytics, utilizing business intelligence tools, care coordination tools, and claims systems to identify issues, mitigate risks, and develop solutions. 
• Serves on standing committees of governance and quality management. 
• Maintains confidentiality in accordance with policies, state and federal laws, rules, and regulations.  
• Manages resources, reporting, and audits processes as needed for compliance. 
• Completes and submits reports to internal committees and state regulators as needed.  

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in nursing, public health, health administration, health policy or business 
• 3+ years of experience in Quality Improvement/Quality Assurance in healthcare
• 3+ years of experience in management and supervision  
• Clinical program development and implementation experience  
• Strong understanding of NCQA Health Plan accreditation standards and requirements  
• Understanding of value-based payment models that reward quality improvement  
• Experience implementing rapid-cycle improvement techniques that demonstrated material improvements  
• Excellent communication skills and experience in cross-functional collaboration 
• Must reside in Indianapolis, Indiana and be willing to work from the office 3 days per week.

Preferred Qualifications

• Master’s degree in nursing, public health, health administration, health policy or business 
• Registered Nurse or equivalent clinical licensure  

• Certified Professional in Healthcare Quality (CPHQ)  

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