[Hiring] Director, Quality Improvement @Humana

Role Description

The Director, Quality Improvement implements quality improvement programs for Louisiana Medicaid, including annual program description, work plan, and annual evaluation. This role is accountable for developing, executing, and continuously refining the market’s quality strategy, ensuring close alignment between local market objectives and enterprise-wide goals.

The Director will be responsible for aligning cross-functional and matrixed teams—including clinical, operational, analytics, and network functions—to drive cohesive quality improvement efforts.

The Director provides strategic leadership for Humana's Louisiana Medicaid Quality Program, ensuring compliance with all contract, state, and federal requirements. Key responsibilities include:

• Operate an NCQA compliant quality program.
• Oversee the development, implementation, and management of quality improvement projects.
• Champion a culture of continuous quality improvement across all functions.
• Partner with various directors to inform population health strategy and target improvement areas.
• Oversee HEDIS, CAHPS, and LDH required measure reporting and evaluation.
• Ensure compliance with quality of care investigations and reporting.
• Provide oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation.
• Improve quality measure performance through innovative approaches.
• Oversee the medical record and treatment record review processes.
• Analyze dashboards consisting of Key Performance Indicators (KPI) and non-KPI metrics.
• Incorporate actionable analytics to identify issues and develop solutions.
• Serve on standing committees of governance and quality management.
• Maintain confidential information in accordance with policies and regulations.

Qualifications

• Bachelor Degree.
• Louisiana-licensed registered nurse, advanced practice registered nurse, physician, or physician's assistant.
• Must be willing to obtain Certification in one of the following within 6 months of hire: Certified Professional in Health Care Quality (CPHQ) or Certified in Health Care Quality and Management (CHCQM).
• Must reside and conduct work in the state of Louisiana.
• 5+ years of management experience in quality.
• 5+ years of Supervisory People Management.
• 5+ years' experience in a fast-paced insurance or health care setting.
• 3+ years' experience in provider relations and education.
• Demonstrated experience working directly with provider organizations.
• Comprehensive knowledge of operational levers necessary to drive quality.
• Understanding of healthcare quality measures STARS, HEDIS, etc.
• Proven analytical skills.
• Excellent communication skills, both oral and written.
• Strong relationship building skills.
• Working knowledge of Value Based Contracting.
• Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.

Requirements

• Master's Degree (preferred).
• Certified Professional in Health Care Quality (CPHQ) and/or Certified in Health Care Quality and Management (CHCQM) (preferred).
• 3+ years leadership experience within a managed care organization (preferred).
• Knowledge of Humana's internal policies, procedures, and systems (preferred).
• Six Sigma or other training in quality management (preferred).
• Experience working with Power Bi (preferred).

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays.
• Volunteer time off.
• Paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.
• Many other opportunities for personal wellness and smart healthcare decisions.