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Humana Healthy Horizons in Virginia is seeking a Director, Quality Improvement who will provide strategic leadership for Humana’s Virginia Medicaid Quality Improvement Program, in alignment with organizational quality and population health goals and ensuring compliance with all contract, state, and federal requirements. The Director, Quality Improvement supports NCQA accreditation and serves as the local health plan lead for accreditation compliance. The Quality Director oversees all aspects of the plan's Quality Assurance and Performance Improvement (QAPI) Program. Their primary responsibility is to operate a quality improvement infrastructure that promotes safety, quality of care, addresses health disparities, is culturally competent, and ensures cost effective access to care in the safest, least restrictive setting. This role requires commitment to cross-functional collaboration that drives continuous quality improvement throughout health plan operations, provider network, and community partnerships to achieve our quality improvement goals and objectives.

               

• Provides oversight of the Quality Assurance and Performance Improvement Program, including supporting documentation such as the Quality Improvement Plan, Annual Evaluation of the QAPI Program, and the annual QAPI work plan.
• Operates the NCQA compliant quality program.
• Oversees the development, implementation, and management of quality improvement projects, including all required Performance Improvement Projects.
• Works collaboratively with the Virginia Department of Medical Assistance Services (DMAS) and others to improve population health outcomes, including addressing health equity and health related social needs (HRSNs).
• Partners with clinical and health equity leadership to develop a population health strategy, design innovative programs, and reduce health disparities.
• Oversees HEDIS, CAHPS, and DMAS required measure reporting and evaluation.
• Ensure compliance with quality-of-care investigations and reporting.
• Improves quality measure performance through innovative approaches in engaging Members and Providers.
• 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 the Quality Committee as required by the Commonwealth.
• Maintains confidential information in accordance with policies, and state and federal laws, rules, and regulations regarding confidentiality.

Use your skills to make an impact
 

Required Qualifications

• Must reside in the state of Virginia.
• Bachelor’s degree in nursing, Education, Public Health, Health Administration, Health Policy, or Business.
• Minimum five (5) years of experience in Quality Improvement/Quality Assurance in the healthcare field.
• Minimum three (3) years of leadership experience.
• Clinical program development and implementation experience.
• Strong understanding of NCQA Health Plan accreditation standards and requirements.
• Experience implementing rapid-cycle improvement techniques that demonstrated material improvements.
• Demonstrated skills in quality improvement concepts, healthcare data analysis, data mining methods and the identification of population health issues, trends, and health disparities using healthcare data sources.
• Understanding of value-based payment models that reward quality improvement.
• Understanding of cultural factors that influence health outcomes and implementing culturally competent improvement interventions.
• Excellent communication skills and experience in cross-functional collaboration in matrixed organizations.

Preferred Qualifications

• Master’s degree in nursing, Education, Public Health, Health Administration, Health Policy, or Business.
• An active, unrestricted Registered Nurse(RN), Physician or Physician’s Assistant license in the state of Virginia.
• CPHQ (Certified Professional in Healthcare Quality) Certification.

Additional Information

• Workstyle: Hybrid Office - The Humana Glen Allen, VA office location is an associate’s primary work location where most of their work week will be spent, but they will work occasionally from home to support focus work and work/life balance needs.​
• Typical Workdays/Hours: Monday - Friday; 8:00am - 5:00pm.
• Travel: Up to 10% in the state of Virginia.
• Direct Reports: up to 8.

Work at Home Criteria

To ensure Home or Hybrid