About Humana



United States

Postal Code:


Approximate Salary:

Not Specified

Position Type:

Full Time

Director of Clinical Care, Quality Compliance

Humana - Louisville, Kentucky

Posted: 12/12/2018


• The Director, Quality Improvement-Clinical Care, designs and implements quality improvement programs for our Partners in Primary Care medical centers in the following areas: clinical operations, clinical programs, and clinical oversight. The Director of Clinical Care, Quality & Compliance will be responsible for assisting the VP with Clinical Operations- clinical strategy development and implementation, Clinical Governance- oversight and activities, Clinical Compliance-management and oversight, and Clinical Programing for the Care Delivery Organization/CDO wholly owned medical facilities. This would include, but not be limited to, co-development of CDO-wide clinical strategy and goals, managing various CDO clinical committees, care integration and clinical programs development and implementation, new product/ technology integration, design and implementation of “test and learn” pilots and clinical quality continuous improvement activities, measurement and analysis of the clinical programs’ outcomes, management of the clinical compliance program, medical services and equipment vendor management oversight, and design, analysis, evaluation and optimization of core model of care processes and workflows.


Daily duties could include:

-        Oversight for clinical quality, compliance, governance and operational functions for Partner in Primary Care medical centers

-        Organizational strategy development around, but not limited to:

o   Organic patient growth/attractive patient-centric brand

o   Best-in-class model of care, clinical quality, and business outcomes

o   Effective clinician recruiting

-        Collaborative development of an effective “CDO University” internal senior care, value-based staff educational and training program

-        Effective collaboration and adoption of performance based/outcome-oriented and value-based organizational culture

-        Leverage data, industry best practices, and previous organizational experience to forecast and develop future quality of care and compliance-related value-added initiatives

-        Review key operational and clinical performance trends, reporting structure, and performance metrics


Required Qualifications

·       Licensed RN, Advanced Nurse Practitioner, or board certified (or eligible) MD or DO with an active, unrestricted state medical license 

·       Ability to obtain additional state licensure/s based on business needs

·       5+ years of technical experience (EMR’s and/or HIMS)

·       Minimum of 3+ years Medicare Advantage clinical practice management or Medicare Advantage health plan administration environment

·       Experience in clinical quality and compliance (HEDIS, STARS, MRA and QI a must)

·       Experience in the design and implementation of clinical, social, and behavioral health program workflows

·       Developing and writing standing orders and protocols

·       Excellent customer service skills (external and internal)

·       Excel at patient interactions/positive and professional demeanor at all times

·       Prior experience with delivering effective presentations to all levels of leadership

·       Demonstrated ability to translate analytics into action and use the data to impact and influence business outcomes

·       Team Player that fosters a team environment for the staff

·       Ability to look at work flow and improve for efficiency and quality

·       Ability to travel at least up to 50% within expansion markets  (associate will be working from Louisville KY Humana office, at least one week of every month, and will travel to different markets two weeks of every month)

·       Ability to travel to all local centers in assigned territory

·       Ability to train others in medical rooming skills, intake skills, and documentation skills

·       Microsoft Office proficiency —Word, Power Point, Access and Excel


Preferred Qualifications


·       Value based care practice and/or value based reimbursement experience

·       Executive leadership and project management experience

·       Six Sigma certification

·       Experience using WebEx for virtual training sessions

·       Bilingual in English and Spanish (fluent professional levels in both)

Scheduled Weekly Hours


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