9 days old

Associate Director, Quality Management (Louisiana Medicaid) - Metairie or Baton Rouge, LA

Humana
Metairie, LA 70001
Description The Associate Director, Quality Improvement implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Associate Director, Quality Improvement requires a solid understanding of how organization capabilities interrelate across department(s). Responsibilities The Associate Director, Quality Management provides strategic leadership for Humanas Louisiana Medicaid Quality Program, in alignment with organizational quality and population health goals and ensuring compliance with all contract, state, and federal requirements. Associate Director, Quality Management oversees the development of the Annual Quality Program Description, Annual Quality Work Plan and Annual Quality Program Evaluation in accordance with NCQA accreditation standards and any applicable contractual requirements. They will support NCQA accreditation and will serve as the local market lead for NCQA accreditation compliance. The Associate Director, Quality Management has oversight of quality investigations and compliance processes, including evaluating and investigations into quality of care concerns. This position has primary responsibility to operate a quality management infrastructure which promotes member safety, quality of care, improves health disparities, is culturally competent and assures cost effective access to care in the safest, least restrictive setting. This role requires commitment to cross-functional collaboration to drive continuous quality improvement throughout health plan operations, provider network and community partnerships to achieve our quality improvement goals and objectives. The Associate Director, Quality Management reports to Humanas Louisiana Medicaid Chief Medical Officer. Essential Functions and Responsibilities + Operate an NCQA compliant quality program. + Oversee the development and implementation of Quality Improvement Projects (QIPs) using rapid-cycle improvement techniques. + Oversee HEDIS, CAHPS, and all LDH required measure reporting and evaluation. + Ensure compliance with quality of care investigations and reporting. + Provide oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation. + Improve quality measure performance through innovative approaches in engaging members and providers. + Work closely with the Chief Population Health Officer to inform population health strategy and target improvement areas including the design of clinical programs that improve health outcomes and reduce health disparities. + Analyze dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes. + Incorporate actionable analytics, utilizing business intelligence tools, care coordination tools, and claims systems to identify issues, mitigate risks, and develop solutions. + Serve on standing committees of governance and quality management. + Responsible for maintaining confidential information in accordance with policies, and state and federal laws, rules and regulations regarding confidentiality. Required Qualifications + Masters degree in public health, health administration, health policy or business. + 5 - 7 years of experience in Quality Improvement/Quality Assurance. + Minimum 5 years of experience in Medicaid programs or program that serves vulnerable populations. + Minimum 5 years of experience in management and supervision. + Clinical program development and implementation experience. + Strong understanding of NCQA Health Plan accreditation standards and requirements. + Demonstrated skills in quality improvement concepts, health care data analysis, data mining methods and the identification of population health issues, trends, and health disparities using health care data sources. + Understanding of value based payment models that reward quality improvement. + Understanding of cultural factors that influence health outcomes and implementing culturally competent improvement interventions. + Experience implementing rapid-cycle improvement techniques that demonstrated material improvements. + Excellent communication skills and experience in cross-functional collaboration in matrixed organizations. Preferred Qualifications + Registered Nurse or equivalent clinical licensure strongly preferred. + Experience with Medicaid behavioral health and the unique quality improvement considerations for behavioral health conditions and providers strongly preferred. + Experience evaluating quality measures at provider level to support value based payment models. + CPHQ certification preferred. Additional Information As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>

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Posted: 2020-02-10 Expires: 2020-03-11

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Associate Director, Quality Management (Louisiana Medicaid) - Metairie or Baton Rouge, LA

Humana
Metairie, LA 70001

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