Quality Improvement - Critical Incident

Humana

2d • $65,000 - $88,600 • Remote

About The Position

Humana Illinois Market is seeking a Process Improvement Professional who analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable business process improvements. The Process Improvement Professional will work with the oversight of the Critical Incidents reported. This oversight process was recognized as a best practice by the Illinois Association of Medicaid Health Plans in 2024 and was awarded their APEX award. Oversight requirements are varied and frequently require interpretation and independent determination of the appropriate courses of action. In this role, the professional must understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Requirements

• Bachelor's degree
• 2 years of experience related to process improvement, compliance measures, or auditing practices or 2 years of experience in Medicaid/Medicare Care Coordination
• Experience in Care Coaching and/or Care Coordination
• Proven oral / written communication and presentation skills.
• Excellent analytical skills, able to manipulate and interpret data

Nice To Haves

• Knowledge of Critical Incident reporting
• Experience in Medicaid or Medicare Guidelines.
• Detail orientated and comfortable working with tight deadlines in a fast-paced environment

Responsibilities

• Collaborate with the Care Coordinators assigned to the case to determine strategies to mitigate further risk to the member.
• Monitor Care Coordination activity and documentation regarding the Critical Incident.
• Collaborate with Leadership staff as needed regarding closure of Critical Incidents.
• Provide oversight for quarterly State audits of Critical incidents.
• Provide reporting to the Illinois Quality Improvement Committee on Critical Incidents and support Annual Quality report.
• Prepare monthly reports to the State regarding Critical Incidents.
• Provide training as needed for new hires and current staff on updates to CIs
• Perform audits focused on improving compliance and quality.
• Review new Critical Incident entries for appropriateness to be classified as a Critical Incident according to guidelines submitted by Illinois oversight agencies
• Development and review of internal quality metrics.
• Support process improvement initiatives. Assist in reviewing new Job Aids to support the team of Learning Design and Learning Facilitation staff.
• Review current Job Aids and Policies and Procedures as requested.
• Create and present education as requested by the Process Improvement Manager.
• Participates in root cause analysis research for audits.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Benefits

• medical
• dental
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level