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DescriptionThe Quality Improvement Lead implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Quality Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial.ResponsibilitiesAt the direction of the Director, Healthcare Quality, the associate will assist in the oversight of the Healthcare Quality program. This involves managing department projects, applications, processes, and reporting requirements; managing oversight of required focused review and other departmental and contract required studies; developing, approving, and monitoring study design, data analysis, collaboration with internal and external stakeholders, and developing required reports; monitoring clinical quality activities for compliance with DoD contract and URAC standards and guidelines. Compile and use data to evaluate quality management activity and outcomes of care. Data analyses to identify needed clinical metrics and identify beneficiaries who may benefit from healthcare improvement initiatives.Key Accountabilities -
Manage department projects, applications, processes, and reporting requirements surrounding oversight of required focused review and other departmental and contract required studies.
Research relevant literature, develop, implement, evaluate, and analyze clinical data, programs, tools, and reports to identify opportunities to improve care and clinical outcomes.
Collaborate and communicate effectively with internal and external customers; including reporting and presentations.
Identify operational barriers and issues, facilitate their resolution, and identify opportunities for improvement.
Ensure department systems, tools, and reports are reviewed, approved and updated.
Required Qualifications
Our Department of Defense contract requires U.S. Citizenship
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
Bachelor's degree, preferably in a healthcare related field
Experience in data analysis, research and clinical studies
3 years in a managed care environment
Extensive analytical skills
Excellent verbal and written communication skills
Advanced computer skills to include experience with SQL and Access
Preferred Qualifications
2 years of management experience
CPHQ
Lean or Six Sigma certification
Scheduled Weekly Hours40About UsMission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity EmployerIt is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.Humana Safety and SecurityHumana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailboxtasrecruit@humana.com to validate the request.
