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

The Senior Quality Improvement Professional implements quality improvement programs for Oklahoma Medicaid, including annual program description, work plan, and annual evaluation. This role works with Medicaid leadership such as the CMO, QI Directors and others to develop meaningful clinical and nonclinical topics that consider areas that the Plan has highlighted as important, the prevalence of a condition in the enrolled population, enrollee demographics and health risks, and the interest/satisfaction of members.

               

Senior Quality Improvement Professional:

• Develops and implements performance improvement projects and oversees PIP's related day-to-day activities

• Acts as lead liaison with internal stakeholders and business partners in the collection of data and intervention information or delegates this responsibility to team members as needed.

• Monitors and audits processes as needed for compliance.

•  Ensures that CMS protocols for PIPs are followed and that all steps outlined in the CMS protocols for performance improvement projects are documented. Completes and submits reports to CMS and State regulators

• Monitors and tracks measures and develops internal strategies for improvement

• Manages quality management system, department SharePoint site, and department reporting

• Makes decisions on moderately complex to complex issues regarding technical approach for project components

• Performs duties with minimal direction

• Exercises considerable latitude in determining objectives and approaches to assignments.

Use your skills to make an impact
 

Required Qualifications:

• Bachelor's degree or 5 years related Quality Improvement 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

• 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

• Must reside in Oklahoma

Preferred Qualifications:

• Lean Six Sigma

• Experience in member/provider education and communications

• Certified Professional in Healthcare Quality (CPHQ)

• Proven analytical skills.

Additional Information

Work at Home Policy

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
• 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

Scheduled Weekly Hours

40

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upg