RN Manager, Quality Improvement – Performance

🔥 0 minutes ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

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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

• Implement quality improvement programs for the Kentucky Medicaid line of business • Develop the annual Quality Improvement program description, work plan, and annual evaluation • Oversee, plan, and implement health plan quality improvement initiatives, including PIPs, medical records documentation audits, and EPSDT • Monitor and implement quality improvement and quality compliance activities for behavioral and physical health • Develop, implement, and monitor the quality assurance and performance improvement program • Monitor the success of quality improvement interventions, including EPSDT • Coordinate resources and manage department reporting • Audit processes for compliance and submit reports to internal committees and state regulators • Lead a team of clinical and non-clinical associates • Manage daily operations of the member/provider outreach program • Manage ongoing medical record documentation review for physical and/or behavioral health • Manage quality improvement activities based on HEDIS, CAHPS, satisfaction, access, and service measures • Manage EPSDT processes and performance • Monitor and report progress toward performance goals and focus measures • Complete quality-related reports for state and internal committees • Participate in interdisciplinary quality improvement workgroups and committees • Manage and update Quality program documents • Travel as needed for state meetings and participate in internal and external multidisciplinary meetings

🎯 Requirements

• Active Registered Nurse (RN) license in Kentucky, in good standing and without disciplinary action • 5+ years of experience in health plan quality improvement and/or quality compliance • 5+ years of experience with healthcare quality measures, such as HEDIS and CAHPS • 3+ years of experience leading member-facing professionals or conducting direct member engagement, with demonstrated results • 3+ years of demonstrated experience analyzing data and preparing formal, data-driven reports • Comprehensive knowledge of Microsoft Office applications, including Word, PowerPoint, Excel, and Teams • Must reside in Kentucky and within commuting distance of Louisville or Frankfort • Ability to work Monday through Friday, 8:00 AM–5:00 PM ET • Dedicated work space without ongoing interruptions to protect member PHI/HIPAA information • Preferred: Experience with Kentucky Medicaid • Preferred: Bilingual proficiency • Preferred: Certified Professional in Healthcare Quality (CPHQ) certification • Preferred: Project management experience

🏖️ 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 • Self-provided internet service meeting minimum speeds of 25 Mbps download and 10 Mbps upload • Remote work arrangement • Occasional travel to Humana offices for training or meetings