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The Director, Quality Improvement implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Director, Quality Improvement requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

               

The Director, Quality Improvement provides leadership for our Indiana Pathways Quality Program, in alignment with organizational quality and population health goals and ensuring compliance with the Indiana Contract, as well as local, state, and federal requirements.  He/she will be responsible for: 

• Directing the activities of the quality management staff in monitoring and auditing the health care delivery system, including, but not limited to, internal processes and procedures, provider network(s), service quality and clinical quality.
• Ensuring a Quality Management infrastructure that promotes member safety, quality of care, reduces disparities, and promotes access to care in the least restrictive setting.
• Responsible for developing, implementing, and monitoring the quality assurance and performance improvement program for quality improvement interventions.  
• Support NCQA accreditation and have oversight of quality investigations and compliance processes, including quality of care concerns.
• Oversees the development, implementation and management of quality improvement projects and work collaboratively to address health equity and social determinants of health 
• Assist the Indiana Pathways Compliance Officer in overseeing the activities of operations to meet the State’s goal of providing health care services that improve the health status and health outcomes of members.
• Oversees HEDIS, CAHPS, and FSSA required measure reporting and evaluation.  
• Ensures compliance with quality-of-care investigations and reporting. 
• Provides oversight of the Annual Quality Program Descriptions, Work Plans, and Program Evaluations 
• Analyzes dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes. 
• Incorporates actionable analytics, utilizing business intelligence tools, care coordination tools, and claims systems to identify issues, mitigate risks, and develop solutions. 
• Serves on standing committees of governance and quality management. 
• Maintains confidentiality in accordance with policies, state and federal laws, rules, and regulations.  
• Manages resources, reporting, and audits processes as needed for compliance. 
• Completes and submits reports to internal committees and state regulators as needed.  

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in nursing, public health, health administration, health policy or business 
• 3 years of experience in Quality Improvement/Quality Assurance in healthcare
• 3 years of experience in management and supervision  
• Clinical program development and implementation experience  
• Strong understanding of NCQA Health Plan accreditation standards and requirements  
• Understanding of value-based payment models that reward quality improvement  
• Experience implementing rapid-cycle improvement techniques that demonstrated material improvements  
• Excellent communication skills and experience in cross-functional collaboration 
• Must reside in Indianapolis, Indiana and be willing to work from the office 3 days per week.

Preferred Qualifications

• Master’s degree in nursing, public health, health administration, health policy or business 
• Registered Nurse or equivalent clinical licensure  

• Certified Professional in Healthcare Quality (CPHQ)  

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• 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
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• 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

Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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 an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) 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 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.

According to the Indiana Office of Inspector General Rule, 42 IAC 1-5-14 Post-Employment Restrictions, if you are a current or former state officer, employee or special state appointee with Indiana Family and Social Services Administration (FSSA) within the past year, engaged in the negotiation or the administration of a Medicaid contract on behalf of the state and/or Family and Social Services Administration (FSSA); in a position to make discretionary decision affecting the: (1) outcome of the negotiation; or (2) nature of the administration; or either engaged in making a regulatory or licensing decision that directly applied to Humana Inc. or to a parent or subsidiary you cannot be considered for this opportunity. For more information please visit:  IG: Indiana Office of Inspector General

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Scheduled Weekly Hours

40

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 because he or she is a protected veteran. 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.