Associate VP Health Plan Quality Improvement and Performance

Atlanta, GA, United States

Associate VP Health Plan Quality Improvement and Performance Location

Atlanta, GA, United States

Posted on

Apr 15, 2022

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Job Information

Humana

Associate VP, Health Plan Quality Improvement and Performance

in

Atlanta

Georgia

Description

The Associate VP, strategically identifies, develops, and implements programs that influence providers, members or market leadership towards value-based relationships and/or improved quality metrics. The Associate VP, requires a in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.

Responsibilities

The AVP, Quality Improvement and Performance will develop, maintain, own and execute strategies to improve performance of the TRICARE contract and maintain performance under Humana Government Business's (HGB) Clinical Quality Management Program. This individual is accountable for the overall quality performance across all care services products including HEDIS, Quality, Value-based care, Accreditation, Contractual and outcome-based strategies.

This is a highly cross-functional position, working with Clinical Operations, Market Operations, Network, Beneficiary Experience, IT, Service Operations, and the Trend and Innovation Teams to understand opportunities for improved quality and to implement evidenced based interventions. This role will collaborate with multiple stakeholders across HGB, as well as across the Enterprise to ensure best practice and learnings are incorporated from across Humana. This role will use data to identify root causes in low quality performance and will facilitate creative problem solving from across the organization to help understand what beneficiaries need to receive better care. This will involve a Population Health lens - all while keeping the beneficiary at the center.

Primary Responsibilities:

Ownership of overall end to end TRICARE Quality Strategy, including execution and results of new programs in a highly cross-functional environment

Collaboration with regional and local plan business leaders to improve quality scores and meet contractual obligations of quality requirements

Facilitate highly cross functional problem-solving spaces to find creative strategies to impact quality - keeping the beneficiary at the center to ensure solutions will have a positive impact/address root causes

Understand and utilize learnings from Enterprise and incorporate them into HGB operations

Ensure program compliance and identifies opportunities to improve service and quality outcomes

Oversees the development and execution of quality/HEDIS program management policies, reporting, procedure; specifically, roadmaps, incorporation of supplemental data sets andchart chase operations

assists in developing clinical management guidelines and value based contracting standards

Utilize project management and intervention skills to evaluate all quality initiatives, track progress and adjust strategy to achieve agreed upon targeted coals

Serves as a quality change agent, and subject matter expert for internal and external stakeholders, including the federal government

Take ownership of quality analytics capabilities - collaborating with Trend and Analytics for reporting of core metrics around HEDIS, experience, and care delivery

Aligns resources across diverse areas such as member services, care management, population health, network, and data/analytics, and IT

Keeps senior staff apprised of opportunities and current performance standards and identifies risks and mitigation strategies to achieving performance goals

Develops new and innovative best practices around critical contractual areas such as Alternative Payment Models (APMs) and delivery system reform.

Develops provider and member driven strategies to close gaps in care and engage with the care system to decrease cost, increase quality, and direct appropriate utilization.

Guide the organization to a continuous quality driven mindset utilizing standardized tools such as, lean, six sigma, PDSA, and total quality management principles

Required Qualifications

7 cumulative years of experience as a Leader overseeing overall quality operations for:

Value Based Care Programs (provider and members)

Quality Reporting

Accreditation/State/Federal quality reporting requirements

Experience with Population Health Management model creation and implementation

3-5 years experience with Accreditation and Contractual QI Requirements including:

Working with State Governments on Quality Requirements

Performance Improvement Project (PIP) implementation

NCQA, URAC, AAAHC, or TJC Accreditation Experience at a health plan or provider based organization

Responsibility for State and/or Federal quality reporting requirements

4 years of experience in Quality Improvement/Quality Assurance in the healthcare field

4 years of management experience leading diverse teams around analytics, operations, and project management

4 years of experience working directly with quality reporting requirements such as HEDIS, CAHPS, Medicare, Medicaid, and Commercial contracts

2 years of experience managing/implementing clinical programs and teams

3-5 years of Value Based Care Experience leading a team through innovation, implementation and execution of:

Provider reporting and quality analytics

Definition of measures, targets and outcomes for VBP arrangements

Experience with various APM model frameworks (pay for quality, partial risk, and full risk models)

Data reconciliation processes for quality improvement efforts and EMR/HIE Integration experience

Clinical program development and implementation experience.

Strong understanding of NCQA Health Plan accreditation standards and requirements.

Demonstrated skills in quality improvement concepts, health care data analysis, data mining methods and the identification of population health issues, trends, and health disparities using health care data sources.

Understanding of cultural factors that influence health outcomes and implementing culturally competent responsive improvement interventions.

Experience implementing rapid-cycle improvement techniques that demonstrated material improvements.

Excellent communication skills and experience in cross-functional collaboration in matrixed organizations.

Minimum of a bachelor's degree

Department of Defense contract requires U.S. citizenship for this position

Successfully receive interim approval for government security clearance (eQIP - electronic questionnaire for investigation processing)

Ability to work East Coast hours regardless of location

Preferred Qualifications

Advanced degree (Masters, Doctoral, MD/DO, Six Sigma/lean certifications, in nursing, public health, health administration, health policy or business)

Certified Professional in Health Care Quality (CPHQ) by the National Association of HealthCare Quality (NAHQ) or

a Certified in HealthCare Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers.

Understanding of TRICARE and knowledge of DHA preferred

Understanding of T5 TRICARE contract requirements for Quality measures, preferred

Additional Information

For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are ahealthcarecompany committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination, including boosteror commit to testing protocols

*OR*

Provide proof of applicable exemption including any required supporting documentation

Medical, religious, state, and remote-only work exemptions are available.

Scheduled Weekly Hours

40

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