Quality Improvement Team Leader - Madison, WI
Humana - Middleton, WI

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This is a work at home opportunity with frequent day travel. The Quality Improvement Team Leader (POD Owner) facilitates an interdepartmental team of around 5 members, working collaboratively with providers. Focus of work is with chronic/complex care members – to come up with solutions to improve member outcomes. The POD/team will work collaboratively with provider groups focused on Senior Product plans to guide, recommend and develop practice specific strategies designed to improve HEDIS scores and all aspects of quality. Primary responsibilities include:

  • Qualify, prioritize, and concentrate Provider visit efforts on top opportunities
  • Develop, facilitate, and/or secure opportunities to positively impact Triple Aim
  • Maintain client relationships, effectively address provider needs & PODS goals
  • Understand the business, industry, and industry trends and use knowledge to recommend effective solutions.
  • Responsible for profit and loss of the POD
  • Lead and/or support collaborative business partnerships, elicit client understanding and insight to advise and make recommendations.
  • Clarify scope of work commitments and deliverables, and define measurable success criteria to monitor progress toward goals.
  • Deliver provider specific metrics and coach providers on gap closing opportunities
  • Facilitate patients’ participation in clinical programs & identify opportunities member participation
  • Define gaps in Humana’s service relationship with providers and facilitate resolution
  • Identify specific practice needs where Humana can provide support
  • Coach provider office staff on best means to communicate with Senior members that may have hearing, vision, physical abilities challenges
  • Develop, enhance and maintain provider clinical relationship across product lines.
  • Establish and foster a healthy working relationship between practice and Humana.
  • Partner with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education.
  • Provide resources and educational opportunities to provider and staff.
  • Capture concerns/issues in action plans as agreed upon by Provider & PODS Owner
  • Document action plans and details of visits and outcomes within CGX
  • Look beyond metrics to identify underlying issues that contribute to gaps.
  • Prioritize Analyst work for PODS specific reporting.
  • Accountable for Provider Prioritization & communication of priorities to PODS team.
  • Facilitate regular Provider Engagement Strategy meetings
  • Accountable for development of Provider specific Care Plans
Assess data, identify opportunities, and understand how the PODS drives successful Triple Aim outcomes.

Qualifications

Role Essentials

  • An active RN license in the designated state
  • Strong interpersonal & relationship building skills
  • Strong influencing, listening, and consultative skills
  • Strong analytical skills, able to manipulate and interpret data
  • CMS Stars/performance measures/HEDIS knowledge and/or experience
  • Utilization management knowledge and/or experience
  • Understanding of clinical programs
  • Coding knowledge and/or experience
  • Office practice/ hospital experience
  • Provider and member rewards program knowledge and experience
  • Organizational and prioritization skills
Role Desirables

  • Bachelor’s degree in a related field
  • Proven leadership/supervisory/management experience
  • Experience in a state and/or federally regulated health care environment
  • Strong business acumen to help drive metrics
Reporting Relationships

This role reports to the POD Leader.

Schedule

:

Full-time

Primary Location

:

US-WI-Middleton

Role

:

Clinical Innovations and Health Practitioners

Work Environment Type

:

Virtual/Work At Home

Travel

:

Yes, 75 % of the Time

Humana - 21 months ago - save job - block
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Humana Inc. (Humana) is a full-service benefits solutions company, offering an array of health and supplemental benefit plans for employer...