COMPLETE Manager, Quality Improvement - Work at Home - Oklahoma

Description

Quality Improvement Manager will implement and monitor quality improvement program components, including annual program description, work plan, and annual evaluation. The Quality Improvement Manager works within specific guidelines and procedures, receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Quality Manager will play a key role in the NCQA accreditation process.

Responsibilities

• The Manager, Quality Improvement ensures the Quality Assessment and Performance Improvement (QAPI) program for Humana Healthy Horizons in Oklahoma operates effectively.
• Supports the Quality Improvement Director on operating an NCQA compliant program.
• Supports the implementation and monitoring of program documents such as program description, work plan, QAPI committee and evaluation, etc.
• Drives quality improvement (QI) efforts. Provides support to staff and communicates daily QI functions.
• Responsible for monitoring and implementing activities related to quality improvement and compliance for both behavioral and physical health.
• Coordinates resources and tactical operations for improvement projects and EPSDT-related initiatives.
• Tracks HEDIS measures with the assistance of the Quality Data Analyst to ensure the plan meets the goals set for the quality withhold measures.
• Manages department reporting; completes and submits state or federal reports as required. Audits data/processes as needed for compliance.
• Conducts briefings and area meetings. Keeps committee meetings minutes.
• Coordinate with interdisciplinary teams (i.e., population health, community engagement, etc.) to integrate quality improvement processes and evidence-based practices.
• Coordinates with relevant internal/external stakeholders, providers, the Oklahoma Health Care Authority, and other entities to maintain quality operations and improve health outcomes.

               

Required Qualifications

• Bachelor's degree in nursing, Public Health or other Health Care Related Field
• 2+ yrs experience in managed care or health care settings
• Strong understanding of healthcare quality measures, HEDIS, CAHPS, STARS ratings
• Understanding of Quality Improvement tools and methodologies (PDSA, root cause analysis, IHI Model for Improvement, etc.)
• 2+ yrs Quality Improvement experience
• Experience in direct provider and/or member engagement
• Experience managing teams (including hiring, training, coaching)
• Demonstrated ability to manage multiple projects and meet deadlines
• Excellent communication skills, both oral and written.
• Comprehensive knowledge of Microsoft Office suite; Microsoft Word, Excel and Power Point
• Must reside in the state of Oklahoma, preferably Oklahoma City

Preferred Qualifications

• Medicaid experience
• CPHQ (Certified Professional in Healthcare Quality) Certification

Workstyle: Hybrid; A combination of remote and Humana's Oklahoma City location.

Our Benefits

Health benefits effective day 1. Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Paid time off, holidays, volunteer time and jury duty pay, Recognition pay.
• 401(k) retirement savings plan with employer match.
• Tuition assistance, Scholarships for eligible dependents.
• Parental and caregiver leave.
• Employee charity matching program.
• Network Resource Groups (NRGs).
• Career development opportunities.

Work at Home Criteria

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours

40