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Job Details

Director Quality Improvement

Location
Tulsa, OK, United States

Posted on
Dec 21, 2022

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Description

The Quality Management Director provides strategic leadership for Humana's Oklahoma Medicaid Quality Program, in alignment with organizational quality and population health goals and ensuring compliance with all contract, state, and federal requirements. This position has primary responsibility to operate a quality management infrastructure which promotes member safety, quality of care, improves health disparities, is culturally responsive and assures cost effective access to care in the safest, least restrictive setting

Responsibilities

The Quality Management Director provides strategic leadership for Humana's Oklahoma Medicaid Quality Program, in alignment with organizational quality and population health goals and ensuring compliance with all contract, state, and federal requirements. They will support NCQA accreditation and will serve as the local market lead for accreditation compliance. The Director has oversight of quality and compliance processes, including evaluating and tracking investigations into quality of care concerns. This position has primary responsibility to operate a quality management infrastructure which promotes member safety, quality of care, improves health disparities, is culturally responsive and assures cost effective access to care in the safest, least restrictive setting. This role requires commitment to cross-functional collaboration to drive continuous quality improvement throughout health plan operations, provider network and community partnerships to achieve our quality improvement goals and objectives.


Provide oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation.
Operate an NCQA compliant quality program.
Oversee the development, implementation and management of quality improvement projects
Work collaboratively with OHCA and others to improve population health outcomes, including addressing health equity and social determinants of health.
Partner with clinical and health equity leadership to develop a population health strategy, design innovative programs, and reduce health disparities.
Oversee HEDIS, CAHPS, and OHCA required measure reporting and evaluation.
Ensure compliance with quality of care investigations and reporting.
Improve quality measure performance through innovative approaches in engaging members and providers.
Analyze dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes.
Incorporate actionable analytics, utilizing business intelligence tools, care coordination tools, and claims systems to identify issues, mitigate risks, and develop solutions.
Serve on standing committees of governance and quality management.
Responsible for maintaining confidential information in accordance with policies, and state and federal laws, rules and regulations regarding confidentiality.


Required Qualifications


Degree in nursing, education, public health, health administration, health policy or business.
Minimum five (5) years of experience in Quality Improvement/Quality Assurance in the healthcare field.
Minimum three (3) years of leadership experience.
Clinical program development and implementation experience.
Strong understanding of NCQA Health Plan accreditation standards and requirements.
Demonstrated skills in quality improvement concepts, health care data analysis, data mining methods and the identification of population health issues, trends, and health disparities using health care data sources.
Understanding of value based payment models that reward quality improvement.
Understanding of cultural factors that influence health outcomes and implementing culturally competent improvement interventions.
Experience implementing rapid-cycle improvement techniques that demonstrated material improvements.
Excellent communication skills and experience in cross-functional collaboration in matrixed organizations.
Must reside in the state of Oklahoma


Preferred Qualifications


CPHQ (Certified Professional in Healthcare Quality) Certification
Registered Nurse (RN), Physician or physician's assistant licensed in the state of Oklahoma without restrictions
Master's Degree in nursing, public health, health administration, health policy or business.
Knowledge of Humana's internal policies, procedures and systems.


Additional Information

Work at Home Policy

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
Associates 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 associates 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


Covid Vaccination Policy

Our company requires vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

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