The Manager, Quality Improvement implements quality improvement programs for the Kentucky Medicaid line of business. This includes quality compliance and quality improvement activities such as the annual Quality Improvement program description, work plan, and annual evaluation, as well as oversees, plans, and implements new and existing health plan quality improvement initiatives, including Performance Improvement Projects (PIPs), medical records documentation audits, and Early Periodic Screening Diagnosis and Testing (EPSDT). The Manager, Quality Improvement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
The Manager, Quality Improvement is responsible for monitoring and implementing activities related to quality improvement and quality compliance for both behavioral and physical health. The Manager, Quality Improvement is responsible for developing, implementing and monitoring the success of the quality assurance and performance improvement program and monitoring the success of quality improvement interventions, including EPSDT. The Manager, Quality Improvement works to coordinate resources and manages department reporting, audits processes as needed for compliance, completes and submits reports to internal committees and state regulators as required.
Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department. The Manager leads a team of both clinical and non-clinical associates and will need to travel as needed for state meetings and participate in other internal and external multidisciplinary meetings.
Essential Role Functions and ResponsibilitiesThe Manager, Quality Improvement is responsible for managing a team of associates responsible for implementing the Kentucky Medicaid Quality Assurance Performance Improvement program. Essential role functions and responsibilities includes, but is not limited to:
- Managing daily operation of member/provider outreach program
- Managing ongoing medical record documentation review for physical and/or behavioral health
- Managing on-going quality improvement activities for both physical and behavioral health based off analysis of performance measures (example HEDIS, CAHPS) or other quality measures (other satisfaction surveys, or other access or services measures)
- Managing EPSDT processes and performance
- Monitoring and reporting progress towards goals for performance and focus measures.
- Completing quality related reports for various state and internal committees
- Participating in interdisciplinary quality improvement workgroups and committees, both internal and external
- Managing and updating Quality program documents including the quality improvement program description, quality improvement work plan, and quality improvement evaluation as appropriate
- Other activities as assigned
Use your skills to make an impact Required Qualifications- Active Registered Nurse (RN) license in Kentucky, in good standing and without disciplinary action.
- 5+ years of experience in health plan quality improvement and/or quality compliance.
- 5+ years of experience with healthcare quality measures, such as HEDIS and CAHPS.
- 3+ years of experience leading member-facing professionals or conducting direct member engagement, with demonstrated results.
- 3+ years of demonstrated experience analyzing data and preparing formal, data-driven reports.
- Comprehensive knowledge of Microsoft Office applications, including Word, PowerPoint, Excel, and Teams
Preferred Qualifications- Experience with Kentucky Medicaid.
- Bilingual proficiency.
- Certified Professional in Healthcare Quality (CPHQ) certification.
- Project management experience.
Additional Information- Schedule/Time Zone: Monday through Friday, 8:00 AM - 5:00 PM ET
- Work Location: Must reside in Kentucky and within commuting distance of Louisville or Frankfort
- Work Style: Remote (Kentucky residents only).
- Travel Requirements: Quarterly travel to Louisville and additional travel to Frankfort as needed.
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.
$86,300 - $118,700 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.
