Role : Clinical Performance Improvement Consultant Assignment: Medicare Location : Torrance, Irvine or Riverside, CA
At Humana, we want to inspire people to live life fully by awakening them to the right choices for themselves and each other. As the healthcare industry changes and evolves, we’re changing too. We’re growing and re-shaping to become an organization that is committed to helping people achieve lifelong well-being. Humana is an organization where change is constant, and we always have our consumers in mind. We’re known as an innovator in our industry, with a history of being out front of where healthcare needs to go. We need people with a passion for helping others and making change happen. We don’t want to be like everyone else in the industry—we want to be better. And we’re looking for talent that wants to grow, be challenged and inspired to help make that happen.
Assignment Capsule Be a part of our Quality Improvement Team-as a Clinical Performance Improvement Consultant you will use your discipline and expertise to influence, lead and educate people and groups in order to optimize Star Quality Ratings.
Humana is seeking a Clinical Performance Improvement Consultant who will be accountable for developing and maintaining key relationships and work with assigned areas to optimize business results.
Serve as the expert in initiatives and processes to achieve excellence in Medicare Star Ratings
Provide regular, comprehensive summaries of critical literature findings and national guidelines that will assist in the development and support of quality programs.
Develop and implement strategy and drive improvement in CAHPS, HOS, HEDIS, and Patient Safety measures.
Lead programs to improve overall Star Ratings
Accurately assess data, identify opportunities, and facilitate cross-departmental prioritization of quality work to drive improved performance across provider groups.
Educate, train, and execute initiatives to improve CAHPS, HOS, HEDIS, and Patient Safety measure scores
Facilitate and collaborate with cross functional teams to develop and implement market focused quality improvement projects/initiatives including corporate activities targeting members and providers, assuring appropriate and timely delivery methods for provider action lists, and other reports/actions as necessary.
Act as a conduit for communication between market operations, corporate teams and key provider groups regarding all quality improvement initiatives.
Develop company capability for sustained, integrated Quality programs building consumer satisfaction, health plan ratings and Provider Engagement.
Key Competencies Builds Trust: Consistently models and inspires high levels of integrity in decisions, speech, and actions. Lives up to commitments, taking responsibility for the impact of one's actions. Exercises the courage to prioritize principles and values over personal or professional gain. Accountability: Meets established expectations and takes responsibility for achieving results; encourages others to do the same. Employs focus, attention to detail, reliability, and appropriate prioritization to drive outcomes. Sees opportunities to contribute and takes the initiative to create solutions. Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first. Develops and strengthens networks and relationships, both inside and outside the organization, that support company performance. Proactively and transparently contributes information and energy toward creating value with others. Executes for Results: Effectively leverages resources to create exceptional outcomes. Determines the best course of action when facing ambiguity. Anticipates and constructively resolves barriers and constraints. Embraces change, applies new knowledge and reconfigures quickly to capitalize on opportunities.
Bachelor’s Degree or equivalent level of experience
Experience in Process Improvement
Proven successful experience in completing efficient health-related research, with associated analysis and conclusions
Strong analytic skills and the ability to use data to drive operational improvement activities
Strong organizational and prioritization skills with ability to collaborate with multiple departments
Detail orientated and comfortable working with tight deadlines in a fast paced environment
Ability to work independently under general instructions, self-directed and motivated
Executive-level communication skills, written and verbal that can be applied to external audiences as well as internal audiences
Excellent PC skills (including MS Word, Access, Excel and PowerPoint)
Strong organizational skills Role Desirables
Master’s Degree in health- or business-related field.
HEDIS, HOS, CAHPS and/or Patient Safety experience
Medicare Stars Ratings knowledge
Collaboration with Providers and/or Medical groups/IPAs
Strong analysis and problem solving skills Reporting Relationships You will report to a Director of Quality/Strategic Consultant, Medicare Quality Stars Leader, CA Market.
Additional Information 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: Quality Performance Improvement Consultant
Other Locations: US-CA-Torrance, US-CA-Riverside
Requisition ID: 191366
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.