Senior Quality Program Delivery Professional (Medicaid)


Location: Company:

Birmingham, AL



Humana Healthy Horizons is seeking a Senior Quality Program Delivery Professional who will manage and support quality improvement program strategies and implementations. The Senior Quality Program Delivery Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
– Plans, organize, monitor, and oversee complex projects with cross-functional teams to deliver defined requirements and meet company strategic objectives related to quality improvement, operations, and analytics.
– Utilize data to identify, develop, and implement evidence-based quality and process improvement strategies.
– Coordinate with cross-departmental teams to implement quality functions and processes.
– Maintains detailed project documentation including meeting minutes, action items, issues lists, project plans, and risk management plans.
– Negotiates with project stakeholders to identify resources, resolve issues, and mitigate risks.
– Provides functional and technical knowledge of quality operations and improvement principles in order to support Humana Healthy Horizon’s quality strategy and implementation approach.
– Work creatively and analytically in a problem-solving environment demonstrating teamwork, innovation and excellence.
– Provides status reporting regarding project milestones, deliverables, dependencies, risks and issues, communicating across leadership.
– Understands interdependencies between technology, operations and business needs.
Required Qualifications
– Bachelor’s degree.
– Minimum three (3) years of experience in healthcare quality.
– Understanding of healthcare quality improvement strategies such as IHI’s Model for Improvement.
– Understanding of healthcare quality measures (example HEDIS).
– Previous experience working with Medicaid or Medicaid populations.
– Prior experience working in a fast paced insurance or health care setting.
– Comprehensive knowledge of Microsoft Office Outlook, Excel, Visio, Word and PowerPoint.
– Excellent communication skills, both oral and written, ability to present to large groups.
– Must have a room in your home designated as a home office; away from high traffic areas where confidential information may be secured.
– 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.
– 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 weekly testing, following all CDC protocols, OR Provide documentation for a medical or religious exemption consideration. This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.
Preferred Qualifications
– Master’s degree in health services, public health, or health care administration or a related field.
– Certified Professional in Health Care Quality (CPHQ).
– Registered Nurse (RN) licensed without restrictions.
– Familiarity with quality operational functions (policies and procedures, medical record review, quality program description/committee/evaluation, NCQA accreditation, etc.).
– Experience developing provider and member facing materials.
– Knowledge of Humana’s internal policies, procedures and systems.
– PMP certification.
– Strong analytical skills.
Additional Information
– Travel: up to 10%
– Work Hours: Eastern Standard Time (EST) but flexible.
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 correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. 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.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours


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