Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.
Responsible for creating and executing the organizations’ vision for quality. The Market Vice President will provide strategic clinical leadership to drive Humana's Clinical Quality Governance Committee by identifying priority focus areas, assigning accountability, receiving feedback on opportunities from business areas and CQIC to guide prioritization, providing guidance, recommendations, and feedback to business areas.
Differentiate Humana by Integrating and embedding clinical quality throughout organization
Implement strategies to distinguish the organization on the basis of clinical quality
Lead cultural change connecting clinical quality to achieve better health outcomes with existing STARS/quality operations by fully embedding quality throughout the organization.
Focus on population health as part of quality
Lead and integrate population health learning and achievements with clinical quality as a critical component for value based care delivery strategy
Relationship and branding
Represent Humana on the national stage, promoting the corporate vision of quality
Optimize Humana relationship and reputation with regulatory and industry organizations
Leadership and development
Responsible for oversight of the newly formed enterprise quality team
Actively coach and develop leaders, with view of other leadership needs across Humana related to quality
Define and manage governance
Develop performance improvement strategies for clinical operations, with specific goals for quality and outcomes across all lines of business
Design and manage structure to support leadership consensus and decision making, oversight of Clinical Quality Governance Committee
Optimize the delivery of reporting/metrics and analysis throughout Humana to ensure gaps in regulatory requirements or anything that would have an impact on minimum levels of member satisfaction, provider engagement, and quality are prioritized and resolved
Lead efforts to achieve accountability and feedback of quality activities
Contribute to the interpretation of quality metrics and creation / maintenance of the quality dashboard
Leadership and Partnerships
Manage operational partners and market leadership to support development of and achieve quality objectives
Translate performance improvement strategies for clinical operations, with specific goals for quality and outcomes across all lines of business, into operational goals.
Develop and lead transformational initiatives focused on engaging and changing the culture across current operational structure.
Connections and relationships
Work cross-functionally with medical management, finance, technology and analytic leaders to systematically embed clinical quality into all operations, which will in turn result in innovative health and wellness solutions to close gaps in care and promote member health and wellness.
Experience driving cultural change embedding clinical quality into business operations.
Understanding of the unique requirements for Medicare, Medicaid and Commercial populations, impact on payer/provider business models.
Experience driving clinical initiatives in large cohorts, achieving utilization and health outcomes, managing NCQA and/or URAC accreditations, working with health plans and communities to improve services, clinical effectiveness, and sustainability.
Successful business and clinical leadership experience in a progressive payer/provider environment as the executive leader of a corporate operation.
Prior leadership experience in care delivery in a clinical environment.
Demonstrated capability to work cross functionally within corporate environments, confirmed by references who will speak to effective leadership, collaboration and partnership on complicated large scale initiatives or operations
Prior Experience in a consulting or project leadership role delivering innovation in systems, processes and client/customer services, with emphasis on metrics and data driven outcomes.
Demonstrated ability to envision and communicate the product of complex business goals and work backwards to ensure all of the requisite steps and details are accounted for.
Master’s degree or equivalent in healthcare field
15+ years of experience in healthcare
At least 5 years of Performance, Process and or Quality Improvement experience in a healthcare setting
Experience working in a health plan
Experience working with regulatory and accrediting agencies
MBA, MMM, MPH, or PhD is optimal
RN, Phd or Rph training and certification optimal
Experience with: CMS Stars, HEDIS, URAQ
Prior leadership experience in care delivery in a clinical or hospital or payor environment optimal
CPHQ certification is optimal
Reporting Relationships You will report to the VP, Office of the Chief Medical Officer.
Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Apply now, or join our Talent Network so you can stay informed and up to date on what’s happening at Humana.
Internal Number: 190220
Humana Inc. (NYSE: HUM) is focused on improving the health of the communities we serve by making it
easy for people to achieve their best health through clinical excellence and coordinated care.
Our diverse lines of business work to serve all types of consumers. From families to seniors to military members to self-employed individuals, there is a plan to meet many unique needs. Humana's associates and corporate leaders are committed to customer service. Our team uses innovation to deliver results to our consumers.