Quality Improvement - Incidents
About The Position
Become a part of our caring community and help us put health first Humana is seeking a Quality Improvement Professional to join the Wisconsin Medicaid Market team. The Quality Improvement Professional monitors incident investigations and compliance processes; manages the incident management system and processes, department SharePoint, and department reporting; audits processes as needed for compliance; completes and submits reports to state regulators as required. Implement quality improvement initiatives related to incident management. Manage the Incident Management System (IMS) that connects to the state reporting system. Review, triage, and process incident reports, quality alerts, and program integrity events applying critical thinking skills to ensure sufficient detail and appropriate follow up and regulatory compliance. Act as a resource to Care Management by providing guidance and education around incident investigation and follow up. Collaborate with Quality Management Leadership and other Departments to ensure appropriate response to immediate member risk or concerns. Assist with the collection, organization, and evaluation of data from incidents, events, quality alerts, and statements of deficiency as a means to identify and address systemic quality concerns. Ensure opportunities for stakeholder involvement in activities aimed at supporting quality through the monitoring of incidents and events. Use your skills to make an impact
Requirements
- Bachelor's degree or more advanced degree in the human services area (Social work, Sociology, Psychology or Nursing) and a minimum of one year experience working with elders, adults with physical disabilities or adults with intellectual disabilities OR bachelor's degree or more advanced degree in any area other than human services with a minimum of 3 years' experience working with elders, adults with physical disabilities or adults with intellectual disabilities.
- 3 years' experience in a health insurance, health care, or long-term services and support setting.
- Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint.
Nice To Haves
- Experience in WI long-term care programs, Family Care or Family Care Partnership, providing care management support to elders and/or adults with physical or intellectual disabilities.
- Experience in data collection, analysis, and reporting.
Responsibilities
- Monitors incident investigations and compliance processes
- Manages the incident management system and processes, department SharePoint, and department reporting
- Audits processes as needed for compliance
- Completes and submits reports to state regulators as required
- Implement quality improvement initiatives related to incident management
- Manage the Incident Management System (IMS) that connects to the state reporting system
- Review, triage, and process incident reports, quality alerts, and program integrity events applying critical thinking skills to ensure sufficient detail and appropriate follow up and regulatory compliance
- Act as a resource to Care Management by providing guidance and education around incident investigation and follow up
- Collaborate with Quality Management Leadership and other Departments to ensure appropriate response to immediate member risk or concerns
- Assist with the collection, organization, and evaluation of data from incidents, events, quality alerts, and statements of deficiency as a means to identify and address systemic quality concerns
- Ensure opportunities for stakeholder involvement in activities aimed at supporting quality through the monitoring of incidents and events
Benefits
- Humana provides medical, dental and 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 and long-term disability, life insurance and many other opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
