Manager, Medicaid Quality Improvement – Remote Ohio | Humana




The Manager, Quality Improvement implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Manager, Quality Improvement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.


The Manager, Quality Improvement monitors quality investigations and compliance processes.

  • Manages quality management system, department SharePoint, and department reporting. Audits processes as needed for compliance.
  • Completes and submits reports to CMS and state regulators as required for clinical studies.
  • Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
  • Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
  • Must reside in Ohio and travel within the state for State meetings
  • Excellent communication and relationship building skills

Required Qualifications

  • Bachelor’s Degree in related field or equivalent experience
  • 3 or more years of leadership experience to include team leadership or supervisory position with hiring, training, coaching
  • 5 years’ experience in the health service industry, healthcare administration, Or healthcare related consulting Or in a fast paced insurance or managed care setting
  • Understanding of healthcare quality measures CMS, HEDIS, Ohio State Guidelines etc.
  • Comprehensive knowledge of Microsoft Office Word, Excel, Visio and PowerPoint
  • Strong problem solving, data-analysis, and critical-thinking skills with the ability to operate and drive progress with limited information and ambiguity
  • Strong presentation skills using PowerPoint and ability to communicate with all levels
  • Must be available to work Monday – Friday 8:00-5:00 with flexibility
  • Must be available to travel within the state of Ohio to attend State Mandated Meetings as required by state
  • For this job, associates are required to be fully COVID vaccinated 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 a healthcare company 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 or 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.

Work At Home Requirements

  • Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.
  • Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.

Travel (see Additional Information)

  • This position will require travel to State Mandated Meetings within the state of Ohio
  • Must have a Valid driver’s license with reliable transportation and the ability to travel within the state of Ohio, as required
  • This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Preferred Qualifications

  • Knowledge of Humana’s internal policies, procedures and systems
  • Previous quality or process improvement experience in a hospital or physician office practice
  • Quality improvement experience with the Medicaid population
  • Certified Professional in Health Care Quality by the National Association for Healthcare Quality (NAHQ)
  • Certified QI Associate by the American Society for Quality
  • Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers

Additional Information

Onsite Travel

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

Scheduled Weekly Hours



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