The Associate Director, Quality Improvement is responsible for working with appropriate departments in the areas of clinical, health services, compliance, process improvement, and member/provider satisfaction for Ohio Medicaid. The Associate Director, Quality Improvement requires a solid understanding of how cross collaboration and organizational capabilities interrelate across department(s). The Associate Director, Quality Improvement requires a high-level knowledge of HEDIS®, CAHPS®, Performance Improvement, and managing a team of associates.
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Associate Director, Quality Improvement implements quality improvement programs and is responsible for enterprise-wide strategy in clinical quality areas in order to maintain a consistent approach across business lines. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s) and leads multiple associates and highly specialized professional associates.
Additional responsibilities:
- Will lead the alignment of Quality Associates and Population Health Stream strategies.
- Lead the focus on MPS measures by population stream and strategy to mitigate penalties.
- Lead the focus on QBA measures and strategy to maintain performance related to membership assignment.
- Focus on HEDIS® project deliverables, driving results and improvement by population stream.
- Focus on CAHPS® project deliverables and impact to population streams (Children, Adults, Behavioral Health, Maternal Health, and Chronic Conditions).
- Provide oversight of Cross-stream Quality Withhold collaborative efforts.
- Lead efforts and focus on vendor and provider engagement from a Quality perspective with dedicated resources and cross collaborative efforts.
- Lead efforts on maintaining quality documentation including policies/procedures, committee minutes/materials, and program documents.
- Lead efforts on maintaining NCQA and EQRO compliance.
- Responsible for maintaining 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- 4 or more years of experience working within Medicaid.
- 2 or more years of current or previous leadership experience (Ideally any experience in leading quality improvement and/or compliance professionals).
- Experience in Quality Improvement/Process Improvement in the healthcare field
- Understanding of cultural factors that influence health outcomes and implementing culturally competent improvement interventions.
- Demonstrated skills in quality improvement concepts, health care data analysis, data mining methods and the identification of population health issues, trends, and health disparities using health care data sources.
- Understanding of value-based payment models that reward quality improvement.
- Excellent communication and presentation skills to include the ability to communicate and present technical/financial details to Senior VP level leadership and/or Senior Government officials.
- Critical thinker who can anticipate team needs and take initiative to present ideas, ask the right questions and deliver the highest quality work.
Preferred Qualifications- Ohio residency is strongly preferred but consideration will be given to non-Ohio based candidates that reside within a driving commute to Columbus, Ohio.
- Associate's Degree in practical nursing, health administration, health policy or business or equivalent work experience.
- CPHQ (Certified Professional in Healthcare Quality) Certification.
- Knowledge of QI methodologies (i.e. IHI model of improvement and familiarity with QI Tools (i.e. FMEA, KDD, workflows/diagrams, root cause analysis etc..)
- Knowledge of Humana's internal policies, procedures, and systems.
Additional Information- Workstyle: This is a Remote position (the state of Ohio or driving distance to Columbus, OH) with travel
- Travel: Up to 20% to Humana's office locations and external agencies in the state of Ohio
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours40
Pay RangeThe 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.
$115,200 - $158,400 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
