Manager, Quality Improvement

🕒 Ontem

🐊 Florida – Remoto

🐊 Florida – Remote

💵 $86.300 - $118.700 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

🦅 Patrocina Visto H1B

Esta empresa já patrocinou vistos H1B no passado.

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Humana

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1961

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

A Humana é uma empresa de saúde dedicada a gerar um impacto positivo na saúde de indivíduos, comunidades e do sistema de saúde como um todo. Com foco em colocar a saúde em primeiro lugar, a Humana atende a uma ampla e diversa gama de populações, incluindo idosos e militares, oferecendo planos Medicare Advantage (HMO, PPO e PFFS). A Humana está comprometida em promover uma cultura de pertencimento e respeito mútuo, oferecendo benefícios competitivos e flexíveis para garantir a segurança financeira de seus funcionários e de suas famílias. A empresa se orgulha de criar um ambiente de trabalho inclusivo, no qual todos têm a oportunidade de ter sucesso.

Descrição

• Lead quality and process improvement initiatives across long-term care programs • 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 improvements • Oversee quality assurance activities and readiness for HEDIS, CAHPS, NCQA accreditation, case file and submission audits, and regulatory requirements • Analyze quality, compliance, and operational data across 80+ metrics and provide actionable insights to leadership • Lead cross-functional projects, pilots, and improvement initiatives from planning through performance monitoring • Oversee corrective actions, remediation activities, and process changes • Partner with clinical, operational, compliance, provider, systems, and leadership teams • Oversee development, documentation, and annual review of market policies, procedures, and support tools • Monitor state and federal regulations, industry trends, and contract changes; resolve contractual non-compliance • Manage accurate and timely completion of required state reports • Partner with corporate teams on system efficiency and new system tools; resolve electronic member file issues • Serve as primary point of contact for process, policy, reporting, data analysis, and system enhancement requests • Develop and maintain performance reporting, dashboards, and monitoring tools • Research best practices and establish benchmark data • Train associates and care partners on process improvement methods, quality standards, and best practices • Lead, coach, and develop up to 15 Quality and Process Improvement associates

🎯 Requisitos

• 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 • ACHA Level II Background Check is required • Professional certification such as CPHQ, PMP, or Lean Six Sigma preferred • Direct experience working within a Medicare or Medicaid managed care health plan preferred • Experience with HEDIS, CAHPS, NCQA, audits, accreditation, or regulatory compliance preferred

🏖️ Benefícios

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Remote work arrangement • Dedicated home workspace and internet requirements for work-from-home employees

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