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 key quality indicators including, but not limited to, HEDIS, 5 Star, Pay-for-Performance (P4P), satisfaction surveys, Annual Quality Reviews (AQR), and External Quality Reviews (EQR). The QI Professional fosters a culture of quality improvement by designing projects and studies in collaboration with appropriate teams that directly impacts members by ensuring data accuracy in reporting, investigation, auditing, and improvement opportunities.

• Assist with the overall Quality Assessment Performance Improvement (QAPI) program for Humana’s Wisconsin Medicaid Market, including compliance with State, Federal, and other managed care regulatory bodies, QAPI mandates, audits, performance improvement projects and reports. 
• Use continuous quality improvement process through tracking and trending data including clinical analysis and reporting for quality monitoring and improvement.
• Provide technical and content-specific expertise to other departments relevant to the identification of, tracking and analysis, and remediation of quality concerns.
• Perform internal audit reviews of system processes to ensure compliance with regulations, polices, procedures.
• Track, trend, synthesize, develop, and distribute written information and reports for internal and external requirements regarding the QAPI program and QI activities (studies, surveys, audits, peer reviews, etc.).
• Represent the team on pertinent internal and external committees and appropriate meetings.
• Assist department management in the development and implementation of new programs for improving and sustaining operating effectiveness and efficiencies.
• Gain subject matter expertise in existing analytical tools and clinical dashboards while providing feedback and guidance in the selection and development of new tools.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in human services or related field or be a licensed Registered Nurse licensed in the state of WI.
• 1-3 years of quality improvement experience in a health care setting.
• 1-2 years of HEDIS experience.
• Experience with and knowledge of both Medicare and Medicaid.
• Experience with data collection, analysis, and reporting.
• Proficiency with Microsoft products, specifically Excel.

Preferred Qualifications

• Experience with Power BI.
• Managed Care experience.
• NCQA knowledge.
• Experience with provider engagement.

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.  
• Work Location: must reside in Wisconsin.
• Travel: up to 50% of travel, mainly throughout southeastern WI, for provider meetings. May require travel outside of this area on occasion.
• Typical Work Days/Hours: Monday – Friday, 8:00 am – 5:00 pm 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.

Driving

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.

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