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Humana Gold Plus Integrated is seeking a Senior Quality Improvement Professional who implements quality improvement programs for Illinois Medicare/Medicaid (MMP) and supports the Quality Assurance and Performance Improvement Program, including annual program description, work plan, and annual evaluation.

The Senior Quality Improvement Professional works with a multidisciplinary team of leadership, clinicians, and analysts to develop meaningful clinical and nonclinical topics that consider areas that the Plan has highlighted as important, the prevalence of a condition in the enrolled population, enrollee demographics and health risks, and the interest/satisfaction of members.

The Senior Quality Improvement Professional roles and responsibilities include:

• Participates in interdepartmental projects and activities.
• Develops and implements performance improvement projects and oversees QIP’S/PIP's related day-to-day activities.
• Acts as lead liaison with internal stakeholders and business partners in the collection of data and intervention information or delegates this responsibility to team members as needed.
• Monitors and audits processes as needed for compliance.
• Ensures that CMS protocols for PIPs are followed and that all steps outlined in the CMS protocols for performance improvement projects are documented.
• Monitors, tracks, measures and develops internal strategies for improvement.
• Makes recommendations based on the analysis of information for improvement based on analysis of results.
• Contributes to feedback loop with leadership and team, communicating and sharing ideas related to process improvement and pertinent information related to measures trending.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components.
• Performs duties with minimal direction.
• Exercises considerable latitude in determining objectives and approaches to assignments.

Use your skills to make an impact
 

Required Qualifications

• 5+ years related Quality Improvement experience.
• Knowledge of QI methodologies (i.e. IHI model of improvement) and familiarity with QI Tools (i.e. FMEA, KDD, workflows/diagrams, root cause analysis).
• ​Demonstrated understanding of healthcare quality measures, including HEDIS, STARS ratings, and CMS.
• Prior experience in a fast-paced health insurance or healthcare setting.
• Proven analytical skills.
• Excellent communication skills, both oral and written to all levels of leadership.
• Strong relationship-building skills working with multi-disciplinary teams (e.g., data scientists/analysts, clinicians, operational leaders, etc.).
• Comprehensive knowledge of Microsoft Office, including Word, Excel, PowerPoint, and Lucid.

Work at Home Requirements

• 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.
• Humana will provide Home or Hybrid Home/Office associates 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.

Preferred Qualifications

• Knowledge of Humana's internal policies, procedures, and systems.
• Lean Six Sigma.
• Experience in healthcare member/provider education and communications.
• Certified Professional in Healthcare Quality (CPHQ).
• Proven analytical skills (i.e. Access, SAS SQL).

Additional Information

• Workstyle: Remote.
• Travel: Up to 20% travel to the Humana office located in Schaumburg, IL.
• Core Workdays & Hours: Typically, 8-5 pm Monday – Friday; Central Standard Time (CST) with flexible scheduling (i.e. occasional nights and weekends).
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from yo