Associate Vice President Quality Improvement for Healthy Horizons

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Job Information
Humana
Associate Vice President, Quality Improvement for Healthy Horizons
in
Atlanta
Georgia
Description
As a company whose primary focus is on the well-being of its members, Humana is dedicated to shifting perceptions of the health insurance industry. We believe our role goes beyond that of a provider to that of a well-being partner who will empower consumers to live a life that is healthy, active and rewarding.
In order to fulfill that mission, we've launched a search focused on identifying an experienced and influential leader to join our team in the role of AVP, Quality Improvement for Healthy Horizons. Decisions in this role are typically related to the implementation of new/updated programs or large-scale projects for the function and support or technical/operational procedures and processes. The incumbent implements strategic plans, drives goals and objectives, and improves performance. This role will report to the Vice-President and Chief Medical Officer for Medicaid and will work closely with all members of the leadership team. This leader will focus on the advancement of Medicaid Clinical Operations and Programs.
Responsibilities
Responsibilities of this role include, but are not limited to:
develop strategic initiatives to ensure that all Medicaid programs meet accreditation standards required by states that have contracts with Humana Healthy Horizons
develop and manage new strategies designed to reduce unwanted variability in clinical interactions with Medicaid recipients
lead initiatives to analyze complex business problems and issues using data from internal and external sources
bring expertise and/or subject matter experts in support of multi-functional efforts to identify, interpret, and produce recommendations and plans based on company and external data analysis
ensure that policies and procedures align with corporate vision
select, develop, and evaluate personnel ensuring efficient operation in areas specifically related to accreditation, auditing and quality
successful management of teams focusing on NCQA accreditation including health equity accreditation, Auditing, Quality metrics, including HEDIS measures, and MHPAEA (Mental Health Parity and Addiction Equity Act)
Support the Medicaid CMO as a strategist, consultant and implementer to ensure streamlined activities based on the priorities of the organization
Ensure consistent visibility for Clinical programs and project teams by monitoring and reporting business objectives, program/project achievements, and key indicators such as results of internal and external auditing
Drive standardization of policies and procedures in these areas
Provide oversight of clinical components related to accreditation and recommends program changes needed to optimize health outcomes
Required Qualifications
Nursing or Bachelor's Degree
8 or more years working in either a clinical environment or within healthcare operations
5 or more years Healthcare or Managed Care leadership experience, particularly Medicaid Managed Care
Experience consulting with senior executives within a large company
Demonstrated ability to develop and implement a clinical strategy
Proven ability to create collaborative relationships within clinical teams and across departments.
Strong presentation development and delivery skills
Preferred Qualifications:
Master's Degree in healthcare field
5 or more years of consulting, management, or strategic project experience
Medicaid managed care experience
In-depth knowledge of how quality metrics and accreditation processes influence the overall strategy to expand Humana's footprint in Medicaid markets
Thorough understanding of the needs of various types of populations eligible for Medicaid, including TANF, women's health, disabled, long-term care and D-SNP
Additional Information
Location - Remote anywhere across the US
Requires travel as business needs dictate, up to 25%
Work-At-Home Requirements: To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested; Satellite, cellular and microwave connection can be used only if approved by leadership; Associates 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 associates 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.
COVID Policy: We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve. 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.
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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