Manager, Quality Improvement

🔥 3 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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This company has sponsored H1B visas in the past.

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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 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

🎯 Requirements

• 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

🏖️ Benefits

• 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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