Manager, Quality Improvement

The Manager, Quality Improvement implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Manager, Quality Improvement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. QI Manager plays a key role on the NCQA Health Plan accreditation and reaccreditation process.

The Manager, Quality Improvement ensures the Quality Assessment and Performance Improvement (QAPI) program for Humana Healthy Horizons in Oklahoma operates effectively.

Drives quality improvement efforts of Humana's Quality Operations.

Supports the implementation and monitoring of program documents such as the program description, work plan, QAPI committee and evaluation, as well as other quality operations, improvement, and compliance functions.

Audits processes as needed for compliance.

Completes and submits state or federal reports as required.

Collaborates and maintains frequent contact with other managers across departments and health plan.

Conducts briefings and area meetings.

Determines the plan's compliance with requirements for NCQA accreditation.

Tracks HEDIS measures along with the assistance of the Quality Data Analyst to ensure the plan meets the goals set for quality measure withholds.

Coordinates with relevant internal/external stakeholders, providers, state department of health and other entities to maintain quality operations and improve health outcomes.

Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.

Required Qualifications

• Must reside in the state of Oklahoma
• Bachelor's degree required
• 2+ years of management or leadership experience
• 2+ years of experience in a fast-paced insurance or healthcare setting
• Familiarity with Quality Improvement tools and methodologies (e.g., PDSA, root cause analysis, IHI Model for Improvement, etc.)
• Understanding of healthcare quality measures such as HEDIS, STARS, etc.
• Demonstrated ability tobuild and maintain strong professional relationships
• Proficient in Microsoft Office Suite, including Word, Excel, and PowerPoint
• Strong analytical and problem-solving skills
• Excellent verbal and written communication skills

Preferred Qualifications

• Experience working with Performance Improvement Projects (PIPs)
• CPHQ (Certified Professional in Healthcare Quality)
• Prior experience with Medicaid programs

Additional Information

• Schedule: Monday through Friday, 8:00 AM – 5:00 PM, with flexibility to work overtime as needed
• Location: Must reside in the state of Oklahoma
• Work Style: Hybrid or remote (Oklahoma residents only)

Work-at-Home (WAH) Internet Statement

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 required; 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