Associate Director, Quality Improvement

** Become a part of our caring community*
* The Associate Director, Quality Improvement is responsible for working with appropriate departments in the areas of clinical, health services, compliance, process improvement, and member/provider satisfaction for Ohio Medicaid. The Associate Director, Quality Improvement requires a solid understanding of how cross collaboration and organizational capabilities interrelate across department(s). The Associate Director, Quality Improvement requires a high-level knowledge of HEDIS®, CAHPS®, Performance Improvement, and managing a team of associates.

The  
** Associate Director, Quality Improvement
** implements quality improvement programs and is responsible for enterprise-wide strategy in clinical quality areas in order to maintain a consistent approach across business lines. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s) and leads multiple associates and highly specialized professional associates.

** Additional responsibilities** :

+ Will lead the alignment of Quality Associates and Population Health Stream strategies.

+ Lead the focus on MPS measures by population stream and strategy to mitigate penalties.

+ Lead the focus on QBA measures and strategy to maintain performance related to membership assignment.

+ Focus on HEDIS® project deliverables, driving results and improvement by population stream.

+ Focus on CAHPS® project deliverables and impact to population streams (Children, Adults, Behavioral Health, Maternal Health, and Chronic Conditions).

+ Provide oversight of Cross-stream Quality Withhold collaborative efforts.

+ Lead efforts and focus on vendor and provider engagement from a Quality perspective with dedicated resources and cross collaborative efforts.

+ Lead efforts on maintaining quality documentation including policies/procedures, committee minutes/materials, and program documents.

+ Lead efforts on maintaining NCQA and EQRO compliance.

+ Responsible for maintaining confidential information in accordance with policies, and state and federal laws, rules, and regulations regarding confidentiality.

** Use your skills to make an impact*
* ** Required Qualifications*
* +  
** 4 or more years of experience working within Medicaid.*
* +  
** 2 or more years of current or previous leadership experience (Ideally any experience in leading quality improvement and/or compliance professionals).*
* + Experience in Quality Improvement/Process Improvement in the healthcare field

+ Understanding of cultural factors that influence health outcomes and implementing culturally competent improvement interventions.

+ 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.

+ Excellent communication and presentation skills to include the ability to communicate and present technical/financial details to Senior VP level leadership and/or Senior Government officials.

+ Critical thinker who can anticipate team needs and take initiative to present ideas, ask the right questions and deliver the highest quality work.

** Preferred Qualifications*
* + Ohio residency is strongly preferred but consideration will be given to non-Ohio based candidates that reside within a driving commute to Columbus, Ohio.

+ Associate's Degree in practical nursing, health administration, health policy or business or equivalent work experience.

+ CPHQ (Certified Professional in Healthcare Quality) Certification.

+ Knowledge of QI methodologies (i.e. IHI model of improvement and familiarity with QI Tools (i.e. FMEA, KDD, workflows/diagrams, root cause analysis etc..)

+ Knowledge of Humana's internal policies, procedures, and systems.

** Additional Information*
* +  
** Workstyle** :
This is a Remote position (the state of Ohio or driving distance to Columbus, OH) with travel

+  
** Travel** :
Up to 20% to Humana's office locations and external agencies in the state of Ohio

Work at Home Requirements:
To ensure Home…