Director, Quality Improvement

Humana • Louisiana, MO

20h • Remote

About The Position

The Director, Quality Improvement implements quality improvement programs for Louisiana Medicaid, including annual program description, work plan, and annual evaluation. This role requires an in-depth understanding of how organization capabilities interrelate across the function or segment and is accountable for developing, executing, and continuously refining the market’s quality strategy, ensuring close alignment between local market objectives and enterprise-wide goals. The Director will be responsible for aligning cross-functional and matrixed teams—including clinical, operational, analytics, and network functions—to drive cohesive quality improvement efforts. The Director, Quality Improvement provides strategic leadership for Humana's Louisiana Medicaid Quality Program, in alignment with organizational quality and population health goals and ensuring compliance with all contract, state, and federal requirements. You will support NCQA accreditation and will be the local market lead for accreditation compliance. The Director, Quality Improvement has oversight of quality and compliance processes, including evaluating and tracking investigations into quality of care concerns. This position has primary responsibility to operate a quality management infrastructure which promotes member safety, quality of care, improves health disparities, is culturally responsive and assures cost effective access to care in the safest, least restrictive setting. A critical component of this role is direct engagement with provider organizations to design, implement, and evaluate quality improvement initiatives. The Director must ensure robust governance structures and engagement models are in place for providers, particularly within value-based arrangements, to foster shared accountability and sustainable performance improvement. The Director must possess a deep understanding of the operational mechanics necessary to execute the quality strategy at the market level, including provider contracting, value-based incentive models, data analytics, and system configuration. This leader must demonstrate proven experience leading within a complex, matrixed environment, with a strong track record of achieving results by influencing without direct authority.

Requirements

• Bachelor Degree
• Louisiana-licensed registered nurse OR advanced practice registered nurse OR physician, OR physician's assistant or must be willing to obtain
• Certification in one of the following within 6 months of hire: Certified Professional in Health Care Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers
• Must reside and conduct work in the state of Louisiana
• 5+ years of management experience in quality
• 5+ years of Supervisory People Management
• 5+ years' experience in a fast-paced insurance or health care setting
• 3+ years' experience in provider relations and education
• Demonstrated experience working directly with provider organizations, including leading quality improvement initiatives and establishing effective quality governance within value-based care arrangements.
• Comprehensive knowledge of operational levers necessary to drive quality, including provider contracting, value-based incentive design, data analytics, and health plan system configuration.
• Understanding of healthcare quality measures STARS, HEDIS, etc.
• Proven analytical skills
• Excellent communication skills, both oral and written
• Strong relationship building skills
• Working knowledge of Value Based Contracting
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint

Nice To Haves

• Master's Degree
• Certified Professional in Health Care Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers
• 3+ years leadership experience within a managed care organization
• Knowledge of Humana's internal policies, procedures and systems
• Six Sigma or other training in quality management
• Experience working with Power Bi working with pivot tables etc.

Responsibilities

• Implement quality improvement programs for Louisiana Medicaid, including annual program description, work plan, and annual evaluation.
• Develop, execute, and continuously refine the market’s quality strategy, ensuring close alignment between local market objectives and enterprise-wide goals.
• Align cross-functional and matrixed teams—including clinical, operational, analytics, and network functions—to drive cohesive quality improvement efforts.
• Provide strategic leadership for Humana's Louisiana Medicaid Quality Program, in alignment with organizational quality and population health goals and ensuring compliance with all contract, state, and federal requirements.
• Support NCQA accreditation and be the local market lead for accreditation compliance.
• Oversee quality and compliance processes, including evaluating and tracking investigations into quality of care concerns.
• Operate a quality management infrastructure which promotes member safety, quality of care, improves health disparities, is culturally responsive and assures cost effective access to care in the safest, least restrictive setting.
• Directly engage with provider organizations to design, implement, and evaluate quality improvement initiatives.
• Ensure robust governance structures and engagement models are in place for providers, particularly within value-based arrangements, to foster shared accountability and sustainable performance improvement.
• Operate an NCQA compliant quality program.
• Oversee the development, implementation and management of quality improvement projects and work collaboratively to address health equity and social determinants of health.
• Champion a culture of continuous quality improvement across all functions, fostering collaboration and engagement in a matrixed environment through strong relationship-building and influence.
• Partner with the CMO, Behavioral Health Medical Director, Health Services Director and Health Equity Director to inform population health strategy and target improvement areas including the design of clinical programs that improve health outcomes and reduce health disparities.
• Oversee HEDIS, CAHPS, and LDH required measure reporting and evaluation.
• Ensure compliance with quality of care investigations and reporting.
• Provide oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation.
• Improve quality measure performance through innovative approaches in engaging members and providers.
• Oversee the medical record and treatment record review processes for the plan.
• Analyze dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes.
• Incorporate actionable analytics, utilizing business intelligence tools, care coordination tools, and claims systems to identify issues, mitigate risks, and develop solutions.
• Serve on standing committees of governance and quality management.
• Responsible for maintaining confidential information in accordance with policies, and state and federal laws, rules and regulations regarding confidentiality.

Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• Short-term disability
• Long-term disability
• Life insurance
• Bonus incentive plan

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees