Humana MRA; Quality Manager in Greenville, South Carolina

Role: MRA-Quality/HEDIS Manager Assignment: Care Delivery Location: Greenville, South Carolina

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. In the Care Delivery Organization (CDO), we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At CDO, we’re seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole.

JOB SUMMARY: Responsible for leading and managing the coding and quality teams in a value-based care strategy and delivery. Will ensure that the market is performing at an optimal level.

Under the supervision and guidance of the Market President, the MRA-Quality/HEDIS Manager holds principal responsibility to oversee coding and quality/HEDIS reporting operations for the market medical centers as well as the MSO affiliates. The MRA-Quality/HEDIS Manager is required to work collaboratively with medical leadership and the clinic and MSO operations leadership in delivering population health management in a cost-effective, quality-oriented manner with great patient experience

In alignment with this focus, we are launching a search to identify a high potential individual who will work with our market providers to improve performance relative to the CMS Five Star Quality Rating Systems, primarily for Medicare Advantage plans (STARS) as well as to improve the quality of clinical documentation. We are seeking an individual who will bring a multi-disciplinary approach to this vital role – including a keen focus on clinical documentation, MRA, and quality, combined with business acumen and a passion for process improvement

MAJOR DUTIES AND RESPONSIBILITIES: MRA Quality/HEDIS Manager is responsible for the medical coders and quality nurses in the affiliate, and denovo models to set best in class documentation , coding and quality-HEDIS reporting processes
* Operationalize strategies, best practices, tools, and the current state (deployment) of the Integrated Care model within the clinical operations as well as the MSO operations around a comprehensive knowledge of accurate coding and documentation and quality/HEDIS-STARs.

  • Build relationships internally with Operations, Finance, Sales, Internal Clinicians, & Medical Directors; successfully working across boundaries in a matrixed organization to understand the interdependencies of clinical care with business initiatives within the Care Delivery Organization.

  • Operationalize strategies around marketing material and educational programs to enhance members and providers understandings of and participation in offerings available for improvements in health outcomes.

  • Fosters a team oriented work enviorment

  • Internally and externally present corporate strategies for specific clinical operations goals specific to quality and outcomes in key functions.

  • Translate transformational initiatives focused on the enhancement of care practices/processes.

  • Navigate cross functionally to solve complex Member and Provider issues

  • 35% travel

  • Interview and hire coders and quality nurses for the market.

  • Responsible for hiring and training new coders and quality nurses for the market.

  • Perform chart review and telephonic coaching sessions with coders quarterly.

    Essentials:

  • Five years certified medical coder

  • Resident of South Carolina

  • Two years of progressive leadership in healthcare administration and operations.

  • Proven interpersonal skills with the ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, medical groups, IPA’s, community organizations and other health plan staff.

  • Knowledge of and experience working with Provider Communities.

  • Knowledge of Excel, Word and Power Point Presentations in a business setting

  • A high level of engagement and emotional intelligence.

  • Direct leadership experience, demonstrating capability in leading cross functional teams.

  • Excellent verbal, written communications skills

    Desirables:

  • RN or LPN

  • Bachelor’s Degree preferably in Business Administration, Healthcare Administration or related field.

  • Experience with Value based coding methodology

  • Proven ability to function effectively in matrix management environment and as a member of an interdisciplinary team

  • Experience with Electronic Medical Records/EMR and/or Health Information Management/HIM systems

  • Solid understanding of medical care delivery, managed care financial arrangements and reimbursement o Experience in health plan, health care management, managed care operations, and/or provider practice within a multi-physician medical center, clinical group, or hospital setting.

    o Knowledge of Population Health Strategy, and Quality based patient care programs.

    o HCC or Risk Coding preferred

    Additional Information Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

    If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

    At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.

Title: MRA; Quality Manager

Location: South Carolina-Greenville

Other Locations: US-South Carolina-Greenville

Requisition ID: 192006

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.