Manager, Provider Quality Improvement

🔥 53 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Lead collaborative provider survey question development, analysis, and improvement interventions • Audit provider-related activities to ensure policies and processes are followed • Refer provider quality issues to external regulatory entities based on complaints or incident reports • Intake, review, and follow up with providers on statements of deficiencies issued by regulatory entities • Collaborate across the organization on provider-related activities and process improvement interventions • Analyze and report provider quality metrics and trends to leadership • Develop the annual quality management program description, work plan, and evaluation • Facilitate the quarterly Provider Advisory Committee • Monitor, analyze, and report incident management performance, trends, risks, timeliness, recurrence, investigation outcomes, and quality metrics • Develop and implement corrective actions, prevention strategies, and quality improvement initiatives based on incident data, root cause analyses, audit findings, and performance results • Report to the Director of Quality Improvement

🎯 Requirements

• Bachelor's Degree • 3 or more years of people management experience • 5 or more years of experience in WI long-term care programs, Family Care or Family Care Partnership • 3 or more years of experience in Quality Management • 1 year of experience in provider relations and education • Must reside in WI or in a bordering state • 1 year of experience developing surveys and audit tools (preferred) • Experience in program development (preferred) • Experience engaging primary care providers such as hospitals, physicians, behavioral health practitioners (preferred) • Minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based upon 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 • Home-based work arrangement • Dedicated home workspace and internet requirements to support remote work • Occasional travel to Humana offices for training or meetings

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