Manager, Provider Quality Improvement

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Oversee the creation, analysis, and enhancement of collaborative provider survey questions.

• Conduct audits of provider-related activities to ensure adherence to policies and procedures.

• Escalate provider quality concerns to external regulatory bodies based on received complaints or incident reports.

• Manage the intake, review, and follow-up process with providers regarding statements of deficiencies issued by regulatory entities.

• Work collaboratively across the organization on provider-related initiatives and process improvement endeavors.

• Analyze and present provider quality metrics and trends to the leadership team.

• Create the annual quality management program description, work plan, and evaluation documentation.

• Facilitate the quarterly meetings of the Provider Advisory Committee.

• Monitor, evaluate, and report on incident management performance, including trends, risks, timeliness, recurrence, investigation outcomes, and quality metrics.

• Develop and execute corrective actions, prevention strategies, and quality improvement initiatives informed by incident data, root cause analyses, audit findings, and performance metrics.

• Report directly to the Director of Quality Improvement.

⛳️ Requirements

• A Bachelor's Degree is required.

• At least 3 years of experience in people management.

• A minimum of 5 years of experience in Wisconsin long-term care programs, Family Care, or Family Care Partnership.

• At least 3 years of experience in Quality Management.

• A minimum of 1 year of experience in provider relations and education.

• Candidates must reside in Wisconsin or a bordering state.

• Preferred: 1 year of experience in developing surveys and audit tools.

• Preferred: Experience in program development.

• Preferred: Experience engaging with primary care providers, including hospitals, physicians, and behavioral health practitioners.

• A minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet is required.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information is necessary.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Comprehensive medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability insurance.

• Life insurance coverage.

• Flexible home-based work arrangement.

• Requirements for a dedicated home workspace and internet to facilitate remote work.

• Occasional travel to Humana offices for training or meetings.