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

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 monitors quality investigations and compliance processes.

Role Overview:

• Manages quality management system, department SharePoint, and department reporting. Audits processes as needed for compliance.
• Completes and submits reports to CMS and state regulators as required for clinical studies.
• Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance.
• Provides input into functions strategy.

Use your skills to make an impact
 

Required Qualifications

• Bachelor Degree 

• Louisiana-licensed registered nurse OR advanced practice registered nurse OR physician, OR physician's assistant or must be willing to obtain Certification in one of the following within 6 months of hire:  

  • Certified Professional in Health Care Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) or 

  • Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers  

• 5+ years of management experience in quality
• 5+ years of Supervisory People Management
• 5+ years’ experience in a fast-paced insurance or health care setting
• 3+ years’ experience in provider relations and education
• Understanding of healthcare quality measures STARS, HEDIS, etc.
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
• Proven analytical skills
• Excellent communication skills, both oral and written
• Strong relationship building skills
• Must reside and conduct work in the state of Louisiana
• Must be available to travel to state meeting as needed by the business; up to 25% - this is a Hybrid role that will report to the office up to 3 days a week.
• Working knowledge of Value Based Contracting

Preferred Qualifications

• Master's Degree 

• Certified Professional in Health Care Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers – move from required.

• ​Knowledge of Humana's internal policies, procedures and systems

• Six Sigma or other training in quality management

• Experience working with Power Bi working with pivot tables etc.

Additional Information

Work-At-Home 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 required; wireless, wired cable or DSL connection is required.
• 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.

Additional Information

Interview Format

 

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience