Associate Director, Quality Improvement

Humana•Work at Home - Ohio, OH

4d•$115,200 - $158,400•Remote

About The Position

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. The 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.

Requirements

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.

Nice To Haves

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.

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.