Description

Humana’s Performance/Quality Improvement (P/QI) Coordinator will focus organizational efforts on improving clinical quality performance measures to achieve optimal performance and quality for the Louisiana Medicaid Plan. They will plan, perform and implement cross-functional initiatives; analyze and measure the effectiveness of existing business processes; and develop sustainable, repeatable, and quantifiable business process improvements. They will work closely with the Quality Director and Quality Management Coordinator and those targeting specialized behavioral health services to promote an organization-wide culture of quality improvement.
Essential Functions and Responsibilities
  • Formulate measurable P/QI goals based on quantitative analysis, company goals, and regulatory expectations and requirements
  • Utilize data to develop intervention strategies to improve outcomes in all areas of care
  • Analyze dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes
  • Develop and implement performance improvement projects using rapid-cycle improvement techniques
  • Collaborate with market teams, corporate departments, and facilitate cross functional work groups to develop strategies to improve effective, appropriate, and culturally-competent delivery of services
  • Develop specific and quantifiable methods for measuring and reporting outcomes
  • Report quality improvement and performance outcomes regularly
  • Prepare and deliver data-driven reports on plan quality performance and quality initiatives for review by relevant committees
  • Author correspondence, proposals, reviews, audit analysis, and technical documentation

Responsibilities

Humana’s Performance/Quality Improvement (P/QI) Coordinator will focus organizational efforts on improving clinical quality performance measures to achieve optimal performance and quality for the Louisiana Medicaid Plan. They will plan, perform and implement cross-functional initiatives; analyze and measure the effectiveness of existing business processes; and develop sustainable, repeatable, and quantifiable business process improvements. They will work closely with the Quality Director and Quality Management Coordinator and those targeting specialized behavioral health services to promote an organization-wide culture of quality improvement.

Essential Functions and Responsibilities

  • Formulate measurable P/QI goals based on quantitative analysis, company goals, and regulatory expectations and requirements.
  • Utilize data to develop intervention strategies to improve outcomes in all areas of care.
  • Analyze dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes.
  • Develop and implement performance improvement projects using rapid-cycle improvement techniques.
  • Collaborate with market teams, corporate departments, and facilitate cross functional work groups to develop strategies to improve effective, appropriate, and culturally-competent delivery of services.
  • Develop specific and quantifiable methods for measuring and reporting outcomes.
  • Report quality improvement and performance outcomes regularly.
  • Prepare and deliver data-driven reports on plan quality performance and quality initiatives for review by relevant committees.
  • Author correspondence, proposals, reviews, audit analysis, and technical documentation.

Required Qualifications

  • Bachelor’s degree in Business, Healthcare, or related field.
  • Certified Professional in Healthcare Quality (CPHQ) or Healthcare Quality Management Certification (CHCQM); or Comparable education and experience in data and outcomes measurement as described in 42 CFR §438.200 – 438.242 of the Federal Medicaid Managed Care Regulations.
  • Minimum five (5) years of clinical or managed care experience in healthcare quality management.
  • Minimum of three (3) years of supervisory experience.
  • Knowledge of complex medical, technical, statistical, and process components relating to quality management, including rapid-cycle improvement, data mining, accreditation, and regulatory guidelines.

Preferred Qualifications

  • Master’s degree in Business, Healthcare, or related field.
  • Knowledge of social supports available in Louisiana or highly engaged in the community they serve.

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


4 days ago - source

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