Quality Improvement Director

Humana • Oklahoma City, OK

1d • $126,300 - $173,700 • Remote

About The Position

The Director, Quality Improvement leads the development, implementation, and evaluation of quality improvement programs across all lines of business, including the annual program description, work plan, and annual evaluation. You will have accountability for quality withhold performance, including monitoring results, identifying improvement opportunities, and driving strategies to optimize performance outcomes. The Director partners across matrixed and cross-functional teams, including teams outside of the direct reporting structure, to improve market quality goals and ensure agreement on priorities. We ask that you have deep expertise in HEDIS, CAHPS, and performance improvement, as well as the ability to lead teams and influence stakeholders across the organization. The QI Director supports resolving complex technical and operational problems within department(s) and leads multiple associates and highly specialized professional associates.

The Director, Quality Improvement leads quality investigations, compliance oversight, and quality improvement operations across all lines of business. This role is accountable for the administration of the quality management system. It is also responsible for oversight of department reporting and documentation platforms. Furthermore, the role executes audit and monitoring activities to ensure compliance with internal, state, and federal requirements. The Director also has responsibility for quality withhold performance, including monitoring results, identifying gaps, and driving improvement strategies to support achievement of enterprise quality goals. You will support NCQA accreditation and will serve as the local market lead for accreditation compliance.

You will ensure accurate and timely preparation and submission of required reports to all regulators. You will collaborate across matrixed and cross-functional teams, including those not directly led by the incumbent, to support implementation of new and revised programs, large-scale initiatives, and operational process improvements. You will exercise broad decision-making authority related to program execution, technical and operational procedures, and performance optimization, while contributing to functional strategy and advancing organizational goals. We are looking for commitment to cross-functional collaboration to drive continuous quality improvement throughout health plan operations, provider network and community partnerships to achieve our quality improvement goals and objectives.

Direct HEDIS project deliverables, driving results and improvement by population stream.
Align Quality and Population Health strategies.
Provide strategic oversight of Cross-stream Quality Withhold collaborative efforts.
Direct efforts on maintaining quality documentation including policies/procedures, committee minutes/materials, and program documents. Provide oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation.
Directs efforts on maintaining NCQA and EQRO compliance.
Maintain confidential information in accordance with policies, and state and federal laws, rules, and regulations regarding confidentiality.
Oversee the development, implementation and management of quality improvement projects including required contract required Performance Improvement Projects (PIPs)
Work collaboratively with OHCA and others to improve health outcomes.
Oversee HEDIS, CAHPS, and OHCA required measure reporting and evaluation.
Improve quality measure performance through innovative approaches in engaging members and providers.
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, using 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.

Requirements

• Bachelors degree in Public Health, Health Administration, Business Administration, Nursing, Healthcare Quality, or a related healthcare or clinical field.
• Minimum five (5) years of experience in Quality Improvement/Quality Assurance in the healthcare field
• 3 or more years of current or previous leadership experience (Ideally any experience in leading quality improvement and/or compliance professionals).
• Prior experience in a fast-paced insurance or health care setting
• Experience in provider relations and education
• Understanding of healthcare quality measures STARS, HEDIS, etc.
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
• Proven analytical skills
• Prior experience demonstrating relationship management and stakeholder engagement skills, with the ability to build strategic partnerships, align diverse teams, and drive results across functions and organizational levels
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• 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..)
• Experience in Quality Improvement/Process Improvement in the healthcare field
• 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.
• Excellent oral and written communication and presentation skills, with a demonstrated ability to effectively represent the organization and the health plan to a broad range of internal and external stakeholders.
• Critical thinker who can anticipate team needs and take initiative to present ideas, ask the right questions and deliver the highest quality work.
• This role requires regular weekly travel to the office in Oklahoma City, OK

Nice To Haves

• Master's degree in Public Health, Health Administration, Business Administration, Nursing, Healthcare Quality, or a related healthcare or clinical field.
• Knowledge of Humana's internal policies, procedures and systems
• CPHQ (Certified Professional in Healthcare Quality) Certification.
• Previous experience with value-based payment models that reward quality improvement.
• Experience working within Medicaid
• History of developing business cases, assess return on investment (ROI), and translate data into actionable recommendations that support health plan performance and value

Responsibilities

• Lead the development, implementation, and evaluation of quality improvement programs.
• Accountable for quality withhold performance, including monitoring results, identifying improvement opportunities, and driving strategies to optimize performance outcomes.
• Partner across matrixed and cross-functional teams to improve market quality goals.
• Lead quality investigations, compliance oversight, and quality improvement operations.
• Administer the quality management system.
• Oversee department reporting and documentation platforms.
• Execute audit and monitoring activities to ensure compliance with internal, state, and federal requirements.
• Support NCQA accreditation and serve as the local market lead for accreditation compliance.
• Ensure accurate and timely preparation and submission of required reports to all regulators.
• Collaborate across teams to support implementation of new and revised programs, large-scale initiatives, and operational process improvements.
• Exercise broad decision-making authority related to program execution, technical and operational procedures, and performance optimization.
• Contribute to functional strategy and advancing organizational goals.
• Drive continuous quality improvement throughout health plan operations, provider network and community partnerships.
• Direct HEDIS project deliverables.
• Align Quality and Population Health strategies.
• Provide strategic oversight of Cross-stream Quality Withhold collaborative efforts.
• Direct efforts on maintaining quality documentation including policies/procedures, committee minutes/materials, and program documents.
• Oversee the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation.
• Direct efforts on maintaining NCQA and EQRO compliance.
• Maintain confidential information in accordance with policies, and state and federal laws, rules, and regulations regarding confidentiality.
• Oversee the development, implementation and management of quality improvement projects including required contract required Performance Improvement Projects (PIPs).
• Work collaboratively with OHCA and others to improve health outcomes.
• Oversee HEDIS, CAHPS, and OHCA required measure reporting and evaluation.
• Improve quality measure performance through innovative approaches in engaging members and providers.
• 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, using 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.

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: Director