Senior Quality Improvement Professional (HEDIS)
About the role
Become a part of our caring community. The Senior Quality Improvement Professional will focus organizational efforts on improving Kentucky Medicaid clinical quality performance measures to achieve optimal performance and quality for the Humana Healthy Horizons in Kentucky Medicaid Plan. Plans, performs, and implements cross-functional initiatives, analyzes and measures the effectiveness of existing business processes, and develops sustainable, repeatable, and quantifiable quality and process improvements. Works closely with the Quality Improvement and market leaders to promote an organization-wide culture of quality improvement. The Senior Quality Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Quality Improvement Professional uses data to develop and lead quality improvement projects and monitors performance metrics for KY Medicaid.
Responsibilities
- Updates, manages, and complies the QI requirement documentation (QI Program Description, QI Work Plans, and QI Evaluation)
- Develops, implements, and evaluates activities of state required Performance Improvement Projects (PIPs) in collaboration with internal and external partners
- Facilitates/participates in quality committees and quality improvement related meetings and discussion with internal and external partners
- Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Develops strategy to improve Performance Measures as identified by the state.
- Assesses drivers for low performing measures
- Develops interventions to improve Performance Measure rates
- Assesses need for