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

The Manager, Provider Quality Improvement implements provider quality monitoring and improvement programs for all lines of business and contributes to the annual quality management program description, work plan, and annual evaluation. The Manager, Provider Quality Improvement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

The Manager, Provider Quality Improvement implements provider quality monitoring and improvement programs for all lines of business and contributes to the annual quality management program description, work plan, and annual evaluation. The Manager, Provider Quality Improvement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities include but are not limited to managing:

• All aspects of provider surveys from leading collaborative survey question development through analysis and improvement interventions;
• Audits of provider related activities ensuring policies and processes are followed;
• Provider quality referrals to external regulatory entities based on complaints or incident reports;
• Intake, review, and follow up with providers on statements of deficiencies issued through regulatory entities;
• Collaboration on provider related activities across the organization, ensuring engagement in process improvement interventions;
• Analysis and reporting on provider quality metrics and trends, including report out to leadership and the development of the annual quality management program description, work plan and evaluation;
• Quarterly Provider Advisory Committee facilitation; and
• Integration of provider policies, processes, and systems across all lines of business.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree
• 5 or more years of management experience
• 5 or more years of experience in WI long-term care programs, Family Care or Family Care Partnership
• Experience in provider relations and education
• Experience developing surveys and audit tools
• Proven analytical skills
• Excellent communication skills, both oral and written
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
• Must be passionate about contributing to an organization focused on continuously improving member experiences

Preferred Qualifications

• 5 of more years of experience in Quality Management
• Experience in program development
• Experience engaging primary care providers such as hospitals, physicians, behavioral health practitioners

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.

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