Manager, Quality Improvement

About the role

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The Manager, Quality Improvement leads quality and process improvement initiatives across long-term care programs, with a strong focus on operational efficiency, continuous improvement, regulatory compliance, and improved member outcomes.

You will lead Quality and Process Improvement associates and partner across clinical, operational, compliance, systems, and leadership teams to identify opportunities, redesign processes, implement solutions, and monitor results. You will provide oversight of quality assurance activities, performance metrics, audits, accreditation readiness, corrective actions, and regulatory requirements.

• Lead process improvement initiatives to improve operational efficiency, service quality, compliance, and member outcomes.
• Assess workflows and business processes to identify gaps, risks, root causes, and improvement opportunities.
• Lead process mapping, procedure development, action planning, and implementation of sustainable process improvements.
• Oversee quality assurance activities and readiness for HEDIS, CAHPS, NCQA accreditation, case file and submission audits, and other regulatory or accreditation requirements.
• Analyze quality, compliance, and operational data across 80+ metrics to identify trends and opportunities and provide actionable insights to leadership.
• Lead cross-functional projects, pilots, and improvement initiatives from planning through implementation and performance monitoring.
• Oversee corrective actions, remediation activities, and process changes resulting from identified quality or compliance gaps.
• Partner with clinical, operational, compliance, provider, systems, and leadership teams to develop and implement solutions.
• Oversee the development, documentation, and annual review of market policies, procedures, and support tools to ensure they remain current, followed, and aligned with state contract, regulatory, and best practice requirements.
• Monitor state and federal regulations, industry trends, and contract changes or amendments; lead timely process changes and resolve any instances of contractual non-compliance.
• Manage the accurate and timely completion of required state reports.
• Partner with corporate teams to improve system efficiency and support development of new system tools; serve as a point of escalation and resolution for system issues affecting associates' use of electronic member files.
• Serve as the primary point of contact for business owners on requests related to processes, policies, reporting, data analysis, and system enhancements.
• Develop and maintain performance reporting, dashboards, and other tools used to monitor quality and process outcomes.
• Research best practices within and outside the organization to establish benchmark data and inform improvement efforts.
• Ensure associates and care partners are trained on process improvement methods, quality standards, and best practices.
• Lead, coach, and develop Quality and Process Improvement associates while promoting accountability, collaboration, and continuous improvement.

Required Qualifications

• Must reside in the state of Florida.
• Bachelor's degree.
• Three (3) or more years of experience leading or supporting healthcare quality improvement or process improvement initiatives.
• Two (2) or more years of formal leadership experience.
• Experience with process mapping, root-cause analysis, workflow assessment, and implementing process or quality improvement initiatives.
• Intermediate to advanced proficiency in Microsoft Office specifically Excel and PowerPoint.
• Working knowledge and understanding of Power BI, including data visualization and reporting.
• Strong analytical skills with experience evaluating quality, operational, or compliance data.
• Strong communication, facilitation, and stakeholder management skills, with the ability to effectively collaborate across teams and organizational levels.
• ACHA Level II Background Check is required.

Preferred Qualifications

• Professional certification such as Certified Professional in Healthcare Quality (CPHQ), Project Management Professional (PMP), or Lean Six Sigma.
• Direct experience working within a Medicare or Medicaid managed care health plan.
• Experience with HEDIS, CAHPS, NCQA, audits, accreditation, or regulatory compliance.

Additional Information

• Workstyle: This is a remote position.
• Travel: Up to 5% within Florida for team engagement and collaborative meetings.
• Typical Workdays/Hours: Monday - Friday; 8:30am- 5:00pm Eastern Time (ET).
• Direct Reports: Up to 15 associates.

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.