Provider Quality Improvement Manager

We are seeking a Provider Quality Improvement Manager to partner across the organization to strengthen provider quality, improve processes, and drive better outcomes. As a key member of our team, you will oversee provider surveys, audits, incident trends, regulatory follow-up, corrective actions, and quality improvement initiatives.

Responsibilities:

• Lead collaborative survey question development, analysis, and improvement interventions for provider surveys
• Conduct audits of provider-related activities to ensure policies and processes are followed
• Make provider quality referrals to external regulatory entities based on complaints or incident reports
• Review and follow up with providers on statements of deficiencies issued through regulatory entities
• Collaborate on provider-related activities across the organization, ensuring engagement in process improvement interventions
• Analyze and report on provider quality metrics and trends, including report out to leadership and development of the annual quality management program description, work plan, and evaluation
• Facilitate quarterly Provider Advisory Committee meetings
• 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

Requirements:

• Bachelor's degree
• 3+ years of people management experience
• 5+ years of experience in WI long-term care programs, Family Care, or Family Care Partnership
• 3+ years of experience in Quality Management
• 1+ year of experience in provider relations and education
• Must reside in WI or 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

Work Arrangements:

• Remote work arrangement with occasional travel to Humana's offices for training or meetings
• Must have a dedicated workspace with minimal interruptions to protect member PHI/HIPAA information
• Reliable internet connection with a minimum download speed of 25 Mbps and upload speed of 10 Mbps

Salary and Benefits:

• Salary range: $86,300 - $118,700 per year
• Eligible for a bonus incentive plan
• Competitive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and more