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The Quality Improvement Director provides strategic leadership for Humana’s Michigan Medicaid Quality Improvement Program, in alignment with organizational quality and population health goals and ensuring compliance with all Contract, State, and federal requirements. The individual in this role supports NCQA accreditation and serves as the local health plan lead for accreditation compliance. The Quality Improvement Director oversees all aspects of the plan's Quality Assurance and Performance Improvement (QAPI) Program. This individual has primary responsibility 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 an NCQA compliant quality program.
• Oversee the development, implementation, and management of quality improvement projects, including all required Performance Improvement Projects.
• Works collaboratively with the Michigan Department of Health and Human Services (MDHHS) 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.
• Oversee HEDIS, CAHPS, and MDHHS required measure reporting and evaluation.
• Ensures compliance with quality-of-care investigations and reporting.
• Improves quality measure performance through innovative approaches in engaging Enrollees 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 State.
• 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 or be willing to relocate to the state of Michigan.
• Bachelor’s degree in nursing, education, public health, health administration, health policy, business or a related field.
• 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 across applicable NCQA accreditation standards and requirements.
• 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.
• Experience implementing rapid-cycle improvement techniques that demonstrated material improvements.
• Excellent communication skills and experience in cross-functional collaboration in matrixed organizations.

Preferred Qualifications

• Master’s Degree.
• CPHQ (Certified Professional in Healthcare Quality) Certification.
• Registered nurse (RN), physician or physician’s assistant licensed in the State of Michigan without restrictions.

Additional Information

• Workstyle: This position's workstyle may begin as Remote but once a new Humana office is established in Detroit, MI or in a surrounding area, the workstyle will change to Hybrid Home.
• Travel: Up to 25 % to MDHSS, througho