Unknown Company is hiring a Director, Quality Improvement

Inclusa/Humana is hiring a Director, Quality Improvement to lead the design and execution of innovative quality improvement programs across all business lines. You will craft and drive annual process improvement projects, quality reporting, and compliance monitoring.

What You'll Do

• Oversee HEDIS, CAHPS, Star ratings, and other State-required measure reporting and evaluation.
• Operate an NCQA compliant quality program.
• Ensure compliance with State health and safety standards, quality-of-care investigations, and reporting.
• Implement clinical and non-clinical quality improvement projects that show substantial improvements year-over-year.
• Improve quality measure performance through innovative approaches to engage members and providers.
• Use actionable analytics, business intelligence, care coordination, and claims system tools to identify issues, mitigate risks, and develop solutions.
• Analyze dashboards of Key Performance Indicators (KPI) and non-KPI metrics, interpreting trends and variances to improve outcomes.
• Enhance value-based reimbursement models with incentives for providers to improve the delivery of quality care.
• Provide oversight of the Annual Quality Program, Annual Quality Work Plan, and the Annual Quality Program Evaluation.
• Serve on standing committees of governance and quality management.
• Maintain confidential information in accordance with policies, and state and federal laws, rules, and regulations regarding confidentiality.

What We're Looking For

• Registered Nurse (RN), physician or physician’s assistant licensed in the state of Wisconsin without restriction, or certification as a Certified Professional in Health Care Quality by NAHQ, Certified QI Associate by the American Society for Quality, and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers. If no certification, must obtain within 6 months from date of hire.
• Bachelor’s degree in a field related to healthcare quality (e.g., nursing, education, public health, health administration, health policy, business or computer science).
• Minimum five (5) years of experience in quality improvement/quality assurance in the healthcare field.
• Minimum three (3) years of leadership/management experience.
• Prior Medicare or Medicaid health plan experience.
• Must be able to travel up to 25% of your time to WI as needed for required meetings and conferences.

Nice to Have

• Master's degree in any field related to healthcare quality.
• CPHQ (Certified Professional in Healthcare Quality) Certification, or comparable achievement.
• Clinical program development and implementation experience.
• Strong understanding of NCQA Health Plan Accreditation standards and requirements.
• Experience with matrixed organizations.
• Knowledge of Humana's internal policies, procedures, and systems.
• Knowledge of acute and primary medical HMO policies and procedures.
• Knowledge of long-term care supports and services policies and procedures.

Technical Stack

• Business intelligence tools
• Care coordination tools
• Claims system tools

Benefits & Compensation

• Compensation: $126,300 - $173,700 per year
• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave
• Short-term and long-term disability
• Life insurance

Work Mode

This is a hybrid position. Your primary office is your home office, with the ability to use Humana office space as needed.

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 protected veteran status.