Become a part of our caring community and help us put health first
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 your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$76,800 - $105,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
