[Hiring] Provider Quality Improvement Manager @Humana

Role Description

If you love digging into data, spotting opportunities, and turning insights into action, this is the role for you! As our Provider Quality Improvement Manager, you'll partner across the organization to strengthen provider quality, improve processes, and help drive better outcomes. Reporting to the Director of Quality Improvement, you'll oversee everything from provider surveys and audits to incident trends, regulatory follow-up, corrective actions, and quality improvement initiatives. You'll bring people and data together to keep quality moving forward.

• All aspects of provider surveys from leading collaborative survey question development through analysis and improvement interventions
• Audits of provider related activities ensuring policies and processes are followed
• Provider quality referrals to external regulatory entities based on complaints or incident reports
• Intake, review, and follow up with providers on statements of deficiencies issued through regulatory entities
• Collaboration on provider related activities across the organization, ensuring engagement in process improvement interventions
• Analysis and reporting on provider quality metrics and trends, including report out to leadership and the development of the annual quality management program description, work plan and evaluation
• Quarterly Provider Advisory Committee facilitation
• Monitor, analyze, and report incident management performance, including trends, risks, timeliness, recurrence, investigation outcomes, and key quality metrics to drive data-informed decision making
• Develop and implement corrective actions, prevention strategies, and quality improvement initiatives based on incident data, root cause analyses, audit findings, and performance results

Qualifications

• Bachelor's Degree
• 3 or more years of people management experience
• 5 or more years of experience in WI long-term care programs, Family Care or Family Care Partnership
• 3 or more years of experience in Quality Management
• 1 year of experience in provider relations and education
• Must reside in WI or in a bordering state

Preferred Qualifications

• 1 year of experience developing surveys and audit tools
• Experience in program development
• Experience engaging primary care providers such as hospitals, physicians, behavioral health practitioners

Workstyle

• Home

Work Hours

• Monday- Friday, 8:00 am – 4:30 pm Central Standard Time (CST)

Work at Home Requirements

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps required
• Wireless, wired cable or DSL connection is suggested
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Travel

• Occasional travel to Humana's offices for training or meetings may be required

Scheduled Weekly Hours

• 40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$86,300 - $118,700 per year

This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Benefits

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

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.