About Humana


Job Category:

Member Quality & Financials - Risk Adjustment & STARS operations


United States

Postal Code:


Approximate Salary:

Not Specified

Position Type:

Full time

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Medicaid Quality Improvement Professional

Humana - Louisville, Kentucky

Posted: 08/9/2018


The Medicaid Quality Improvement Professional (aka Program Delivery Professional 2) strategically identifies, develops, and implements programs that influence providers, members or market leadership towards value-based relationships and/or improved quality metrics. The Program Delivery Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.


The Program Delivery Professional 2 develops programs designed to drive value-based relationships. Partners with leaders regarding implementation planning. Reviews and communicates results of programs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

In this role, you will work directly with internal customers to help guide Humana’s decision makers (executives to front-line leaders) to maximize quality effectiveness, enhance quality of care, and minimize waste and variability within the healthcare delivery system using your consulting, analytics and problem solving skills.


  • Assess and influence Humana’s Medicaid healthcare quality operations strategies and tactics using in-depth analytics and knowledge of healthcare industry best practices and new innovations
  • Build effective relationships with all business partners and stakeholders.
  • Work closely with partners in the Healthcare Quality, Reporting, and Improvement organization, the Medicaid markets, and throughout the enterprise to understand the specific needs of those partners and organizations and develop risk adjustment and quality initiatives that deliver the right behavior and interventions for our members and providers.
  • Develop subject matter expertise in the latest quality improvement and risk adjustment methods for Humana’s Medicaid programs and serve as a consulting resource for the needs of partners across the enterprise.
  • Examine and communicate trends to senior leaders regarding opportunities to improve opportunities in quality and risk adjustment.

Required Qualifications

  • Bachelor’s Degree
  • 2+ years' healthcare experience with a proven ability to make independent decisions that drive business results
  • Strong understanding of healthcare policy developments; such as the Affordable Care Act, Medicaid and/or Medicare
  • Comfortable defining own work priorities and timelines with limited supervision
  • Excellent PC skills (including MS Office Suite)
  • Ability to exercise independent judgment with minimal direction many times under ambiguous circumstances
  • Strong written and verbal communication. Strong problem solving and reasoning skills.
  • Ability to work in a matrix management environment
  • Ability to process complex concepts and deliver in an easy to understand format

Preferred Qualifications

  • Interest and ability to define and pursue understanding of a customer’s business obstacles to success and the ability to make clear solution recommendations
  • A strong desire to serve Humana’s underserved and vulnerable membership 
  • General understanding of Risk Adjustment, specifically CDPS + Rx
  • Exposure to established industry standards for measuring healthcare quality: HEDIS, CAHPS, HOS, and other quality metrics
  • Prior analytical experience with Medicaid and/or other healthcare data (SQL experience is a plus)

Scheduled Weekly Hours


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