Manager Quality Compliance

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Job Information
Humana
Manager, Quality Compliance
in
Metairie
Louisiana
Description
Humana Healthy Horizons in Louisiana is seeking a Manager, Quality Improvement who will implement and monitor quality improvement program components, including annual program description, work plan, and annual evaluation. The Manager, Quality Improvement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Quality manager will play a key role in the NCQA accreditation process.
Responsibilities
The Manager, Quality Improvement ensures the Quality Assessment and Performance Improvement (QAPI) program for Humana Healthy Horizons in Louisiana operates effectively.
Drives quality improvement efforts of Humana's Quality Operations.
Supports the implementation and monitoring of program documents such as the program description, work plan, QAPI committee and evaluation, as well as other quality operations, improvement, and compliance functions.
Audits processes as needed for compliance.
Completes and submits state or federal reports as required.
Collaborates and maintains frequent contact with other managers across departments and health plan.
Conducts briefings and area meetings.
Determines the plan's compliance with all requirements for NCQA accreditation.
Tracks HEDIS measures along with the assistance of the Quality Data Analyst to ensure the plan meets the goals set for quality measure withholds.
Coordinates with relevant internal/external stakeholders, providers, the Louisiana Department of Health (LDH), and other entities to address quality of care issues associated with enrollee grievances for Physical Health.
Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
Required Qualifications
Must reside in the state of Louisiana.
Bachelor's Degree or 5 years related work experience in healthcare quality improvement.
2 or more years of management/leadership experience.
Understanding of healthcare quality measures STARS, HEDIS, etc.
Prior experience in a fast paced insurance or health care setting.
Comprehensive knowledge of Microsoft Office suite.
Excellent communication skills, both oral and written.
This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
Must have the ability to provide a high-speed DSL or cable modem for a home office.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Preferred Qualifications
Masters degree in a related field.
CPHQ certification.
Knowledge of Humana's internal policies, procedures and systems.
Experience in provider relations and education.
Experience with NCQA accreditation.
Understanding of Quality Improvement tools and methodologies (PDSA, root cause analysis, IHI Model for Improvement, etc.)
Proven analytical skills.
Additional Information
Workstyle:
Hybrid Home
- 3 - 4 days/week remotely and 1 - 2/days per week in Humana's Metairie, Louisiana location.
Travel:
Up to 20% to internal market meetings and external client meetings.
Direct Reports:
Up to 6 associates.
Benefits:
Effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes; 401k, Medical, Dental, Vision and a variety of supplemental insurances​, tuition assistance and much more.....
Vaccination Statement:
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH's Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov) (****opinion)
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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 or computer 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
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

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