Director, Quality Improvement

Become a part of our caring community
 

The Director, Quality Improvement implements quality improvement programs for Louisiana Medicaid, including annual program description, work plan, and annual evaluation. The Director, Quality Improvement requires an in-depth understanding of how organization capabilities interrelate across the function or segment. This role is accountable for developing, executing, and continuously refining the market’s quality strategy, ensuring close alignment between local market objectives and enterprise-wide goals. The Director will be responsible for aligning cross-functional and matrixed teams—including clinical, operational, analytics, and network functions—to drive cohesive quality improvement efforts.

The Director, Quality Improvement provides strategic leadership for Humana's Louisiana Medicaid Quality Program, in alignment with organizational quality and population health goals and ensuring compliance with all contract, state, and federal requirements. You will support NCQA accreditation and will be the local market lead for accreditation compliance. The Director, Quality Improvement has oversight of quality and compliance processes, including evaluating and tracking 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 responsive and assures cost effective access to care in the safest, least restrictive setting.

A critical component of this role is direct engagement with provider organizations to design, implement, and evaluate quality improvement initiatives. The Director must ensure robust governance structures and engagement models are in place for providers, particularly within value-based arrangements, to foster shared accountability and sustainable performance improvement.

The Director must possess a deep understanding of the operational mechanics necessary to execute the quality strategy at the market level, including provider contracting, value-based incentive models, data analytics, and system configuration.

This leader must demonstrate proven experience leading within a complex, matrixed environment, with a strong track record of achieving results by influencing without direct authority.

Other key responsibilities include:

Operate an NCQA compliant quality program.

• Oversee the development, implementation and management of quality improvement projects and work collaboratively to address health equity and social determinants of health.
• Champion a culture of continuous quality improvement across all functions, fostering collaboration and engagement in a matrixed environment through strong relationship-building and influence.
• Partner with the CMO, Behavioral Health Medical Director, Health Services Director and Health Equity Director to inform population health strategy and target improvement areas including the design of clinical programs that improve health outcomes and reduce health disparities.
• Oversee HEDIS, CAHPS, and 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.
• Oversee the medical record and treatment record review processes for the plan
• 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.

Use your skills to make an impact
 

Required Qualifications

• Bachelor Degree

• Louisiana-licensed registered nurse OR advanced practice registered nurse OR physician, OR physician's assistant or must be willing to obtain Certification in one of the following within 6 months of hire: Certified Professional in Health Care Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers

• Must reside and conduct work in the state of Louisiana

• 5+ years of management experience in quality

• 5+ years of Supervisory People Management

• 5+ years' experience in a fast-paced insurance or health care setting

• 3+ years' experience in provider relations and education

• Demonstrated experience working directly with provider organizations, including leading quality improvement initiatives and establishing effective quality governance within value-based care arrangements.

• Comprehensive knowledge of operational levers necessary to drive quality, including provider contracting, value-based incentive design, data analytics, and health plan system configuration.

• Understanding of healthcare quality measures STARS, HEDIS, etc.

• Proven analytical skills

• Excellent communication skills, both oral and written

• Strong relationship building skills

• Working knowledge of Value Based Contracting

• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint

Preferred Qualifications

• Master's Degree 

• Certified Professional in Health Care Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers

• 3+ years leadership experience within a managed care organization

• ​Knowledge of Humana's internal policies, procedures and systems

• Six Sigma or other training in quality management

• Experience working with Power Bi working with pivot tables etc.

Additional Information

Work at Home Guidance

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$126,300 - $173,700 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

​
Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.