Manager, Provider Quality Improvement

Become a part of our caring community

If you love digging into data, spotting opportunities, and turning insights into action, this is the role for you! As our Provider Quality Improvement Manager, you'll partner across the organization to strengthen provider quality, improve processes, and help drive better outcomes. Reporting to the Director of Quality Improvement, you'll oversee everything from provider surveys and audits to incident trends, regulatory follow-up, corrective actions, and quality improvement initiatives. You'll bring people and data together to keep quality moving forward.

Main Responsibilities:

• All aspects of provider surveys from leading collaborative survey question development through analysis and improvement interventions

• Audits of provider related activities ensuring policies and processes are followed

• Provider quality referrals to external regulatory entities based on complaints or incident reports

• Intake, review, and follow up with providers on statements of deficiencies issued through regulatory entities

• Collaboration on provider related activities across the organization, ensuring engagement in process improvement interventions

• Analysis and reporting on provider quality metrics and trends, including report out to leadership and the development of the annual quality management program description, work plan and evaluation

• Quarterly Provider Advisory Committee facilitation

• Monitor, analyze, and report incident management performance, including trends, risks, timeliness, recurrence, investigation outcomes, and key quality metrics to drive data-informed decision making.

• Develop and implement corrective actions, prevention strategies, and quality improvement initiatives based on incident data, root cause analyses, audit findings, and performance results.

Use your skills to make an impact

Required Qualifications

• Bachelor's Degree

• 3 or more years of people management experience

• 5 or more years of experience in WI long-term care programs, Family Care or Family Care Partnership

• 3 or more years of experience in Quality Management

• 1 year of experience in provider relations and education

• Must reside in WI or in a bordering state

Preferred Qualifications

• 1 year of experience developing surveys and audit tools

• Experience in program development

• Experience engaging primary care providers such as hospitals, physicians, behavioral health practitioners

Additional Information

• Workstyle : Home

• Work Hours : Monday- Friday, 8:00 am – 4:30 pm Central Standard Time (CST)

Work at Home Requirements: 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 suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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.

$86,300 - $118,700 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.

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.

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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.