[Hiring] Manager, Quality Improvement @Humana

Role Description

The Manager, Quality Improvement leads quality and process improvement initiatives across long-term care programs, with a strong focus on operational efficiency, continuous improvement, regulatory compliance, and improved member outcomes. You will lead Quality and Process Improvement associates and partner across clinical, operational, compliance, systems, and leadership teams to identify opportunities, redesign processes, implement solutions, and monitor results. You will provide oversight of quality assurance activities, performance metrics, audits, accreditation readiness, corrective actions, and regulatory requirements.

• Lead process improvement initiatives to improve operational efficiency, service quality, compliance, and member outcomes.
• Assess workflows and business processes to identify gaps, risks, root causes, and improvement opportunities.
• Lead process mapping, procedure development, action planning, and implementation of sustainable process improvements.
• Oversee quality assurance activities and readiness for HEDIS, CAHPS, NCQA accreditation, case file and submission audits, and other regulatory or accreditation requirements.
• Analyze quality, compliance, and operational data across 80+ metrics to identify trends and opportunities and provide actionable insights to leadership.
• Lead cross-functional projects, pilots, and improvement initiatives from planning through implementation and performance monitoring.
• Oversee corrective actions, remediation activities, and process changes resulting from identified quality or compliance gaps.
• Partner with clinical, operational, compliance, provider, systems, and leadership teams to develop and implement solutions.
• Oversee the development, documentation, and annual review of market policies, procedures, and support tools to ensure they remain current, followed, and aligned with state contract, regulatory, and best practice requirements.
• Monitor state and federal regulations, industry trends, and contract changes or amendments; lead timely process changes and resolve any instances of contractual non-compliance.
• Manage the accurate and timely completion of required state reports.
• Partner with corporate teams to improve system efficiency and support development of new system tools; serve as a point of escalation and resolution for system issues affecting associates' use of electronic member files.
• Serve as the primary point of contact for business owners on requests related to processes, policies, reporting, data analysis, and system enhancements.
• Develop and maintain performance reporting, dashboards, and other tools used to monitor quality and process outcomes.
• Research best practices within and outside the organization to establish benchmark data and inform improvement efforts.
• Ensure associates and care partners are trained on process improvement methods, quality standards, and best practices.
• Lead, coach, and develop Quality and Process Improvement associates while promoting accountability, collaboration, and continuous improvement.

Qualifications

• Must reside in the state of Florida.
• Bachelor's degree.
• Three (3) or more years of experience leading or supporting healthcare quality improvement or process improvement initiatives.
• Two (2) or more years of formal leadership experience.
• Experience with process mapping, root-cause analysis, workflow assessment, and implementing process or quality improvement initiatives.
• Intermediate to advanced proficiency in Microsoft Office specifically Excel and PowerPoint.
• Working knowledge and understanding of Power BI, including data visualization and reporting.
• Strong analytical skills with experience evaluating quality, operational, or compliance data.
• Strong communication, facilitation, and stakeholder management skills, with the ability to effectively collaborate across teams and organizational levels.
• ACHA Level II Background Check is required.

Preferred Qualifications

• Professional certification such as Certified Professional in Healthcare Quality (CPHQ), Project Management Professional (PMP), or Lean Six Sigma.
• Direct experience working within a Medicare or Medicaid managed care health plan.
• Experience with HEDIS, CAHPS, NCQA, audits, accreditation, or regulatory compliance.

Additional Information

• Workstyle: This is a remote position.
• Travel: Up to 5% within Florida for team engagement and collaborative meetings.
• Typical Workdays/Hours: Monday – Friday; 8:30am– 5:00pm Eastern Time (ET).
• Direct Reports: Up to 15 associates.
• Work at Home Requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours: 40.
• Pay Range: $86,300 - $118,700 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.

Description of 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 and many other opportunities.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.