Associate Director, Quality Improvement
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Job Description
Associate Director leading Ohio Medicaid quality improvement, HEDIS, CAHPS, compliance, and population-health strategy at Humana. Managing quality teams, providers, vendors, and enterprise-wide clinical improvement programs.
Responsibilities:
- Work with clinical, health services, compliance, process improvement, and member/provider satisfaction departments for Ohio Medicaid
- Implement quality improvement programs
- Develop and execute enterprise-wide strategy in clinical quality areas across business lines
- Identify and resolve complex technical and operational problems within departments
- Lead multiple associates and highly specialized professional associates
- Align Quality Associates and Population Health Stream strategies
- Lead MPS measures by population stream and strategies to mitigate penalties
- Lead QBA measures and strategies related to membership assignment performance
- Oversee HEDIS project deliverables and drive results and improvement by population stream
- Oversee CAHPS project deliverables and impact across children, adults, behavioral health, maternal health, and chronic conditions
- Provide oversight of Cross-stream Quality Withhold collaborative efforts
- Lead vendor and provider engagement from a Quality perspective
- Maintain quality documentation, including policies/procedures, committee minutes/materials, and program documents
- Lead efforts to maintain NCQA and EQRO compliance
- Maintain confidential information in accordance with policies and state and federal confidentiality laws, rules, and regulations
Requirements:
- 4 or more years of experience working within Medicaid
- 2 or more years of current or previous leadership experience
- Experience in Quality Improvement/Process Improvement in the healthcare field
- Understanding of cultural factors influencing health outcomes and implementing culturally competent improvement interventions
- Demonstrated skills in quality improvement concepts, healthcare data analysis, data mining methods, and identifying population health issues, trends, and health disparities using healthcare data sources
- Understanding of value-based payment models that reward quality improvement
- Excellent communication and presentation skills, including communicating technical/financial details to Senior VP-level leadership and/or Senior Government officials
- Critical-thinking and initiative skills
- Ohio residency strongly preferred; non-Ohio candidates considered if within driving commute to Columbus, Ohio
- Associate's Degree in practical nursing, health administration, health policy or business or equivalent work experience (preferred)
- CPHQ Certification (preferred)
- Knowledge of QI methodologies, including IHI model of improvement, FMEA, KDD, workflows/diagrams, and root cause analysis (preferred)
- Knowledge of Humana's internal policies, procedures, and systems (preferred)
- Ability to work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
Benefits:
- Bonus incentive plan based on company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Home or Hybrid Home/Office employees receive work-from-home flexibility
- Up to 20% travel to Humana office locations and external agencies in Ohio
- Internet service requirement/support for home work: minimum 25 Mbps download and 10 Mbps upload
- Dedicated workspace arrangement for protecting member PHI/HIPAA information
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