Associate Director, Quality Improvement

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. This role requires a solid understanding of how cross-collaboration and organizational capabilities interrelate across departments and a high-level knowledge of HEDIS®, CAHPS®, Performance Improvement, and managing a team of associates.

Responsibilities

• Implement quality improvement programs and develop enterprise-wide strategy in clinical quality areas to maintain a consistent approach across business lines.
• Lead the alignment of Quality Associates and Population Health Stream strategies.
• 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.
• Drive HEDIS® project deliverables, results, and improvement by population stream.
• Focus on CAHPS® project deliverables and their impact on population streams (Children, Adults, Behavioral Health, Maternal Health, and Chronic Conditions).
• Provide oversight of Cross-stream Quality Withhold collaborative efforts.
• Lead efforts on vendor and provider engagement from a Quality perspective with dedicated resources and cross-collaborative efforts.
• Maintain quality documentation including policies/procedures, committee minutes/materials, and program documents.
• Ensure NCQA and EQRO compliance.
• Maintain confidential information in accordance with policies, state, and federal laws, rules, and regulations regarding confidentiality.

Requirements

• 4 or more years of experience working within Medicaid.
• 2 or more years of current or previous leadership experience (ideally 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, healthcare data analysis, data mining methods, and identification of population health issues, trends, and disparities using healthcare data sources.
• Understanding of value-based payment models that reward quality improvement.
• Excellent communication and presentation skills, including the ability to communicate technical/financial details to Senior VP-level leadership and/or Senior Government officials.
• Critical thinker who can anticipate team needs, take initiative, and deliver high-quality work.

Qualifications

• 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 (preferred).
• Knowledge of QI methodologies (e.g., IHI model of improvement) and familiarity with QI tools (e.g., FMEA, KDD, workflows/diagrams, root cause analysis).
• Knowledge of Humana's internal policies, procedures, and systems (preferred).

Schedule

• Scheduled weekly hours: 40.
• This is a remote position based in the state of Ohio or within driving distance to Columbus, OH, with up to 20% travel to Humana's office locations and external agencies in Ohio.

Work-at-home requirements include a dedicated workspace free from interruptions to protect member PHI/HIPAA information. Minimum internet speed: 25 Mbps download and 10 Mbps upload (wired cable or DSL connection suggested). Humana reserves the right to require associates to upgrade their internet service if necessary.

Pay

The pay range for this role is $115,200 - $158,400 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.