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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Quality Management and Provider Relations, with a strong focus on developing and implementing quality improvement initiatives and corrective actions. Proven ability to analyze provider quality metrics and collaborate across organizations to enhance provider-related activities.
Highest-signal resume keywords
Quality Management ExperienceProvider RelationsPeople ManagementProgram DevelopmentSurvey Development
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality Improvement InitiativesData AnalysisIncident ManagementAudit Tools DevelopmentRoot Cause AnalysisPerformance Metrics ReportingCorrective Action DevelopmentProcess ImprovementProvider Survey DevelopmentQuality Metrics Analysis
Soft Skills
CollaborationLeadershipCommunicationProblem-SolvingInterpersonal Skills
Industry Keywords
Long-Term Care ProgramsFamily CareFamily Care PartnershipRegulatory CompliancePHI/HIPAA Compliance
About the role
Key responsibilities & impact- Lead collaborative provider survey question development, analysis, and improvement interventions
- Audit provider-related activities to ensure policies and processes are followed
- Refer provider quality issues to external regulatory entities based on complaints or incident reports
- Intake, review, and follow up with providers on statements of deficiencies issued by regulatory entities
- Collaborate across the organization on provider-related activities and process improvement interventions
- Analyze and report provider quality metrics and trends to leadership
- Develop the annual quality management program description, work plan, and evaluation
- Facilitate the quarterly Provider Advisory Committee
- Monitor, analyze, and report incident management performance, trends, risks, timeliness, recurrence, investigation outcomes, and quality metrics
- Develop and implement corrective actions, prevention strategies, and quality improvement initiatives based on incident data, root cause analyses, audit findings, and performance results
- Report to the Director of Quality Improvement
Requirements
What you’ll need- Bachelor's Degree
- 3 or more years of people management experience
- 5 or more years of experience in WI long-term care programs, Family Care or Family Care Partnership
- 3 or more years of experience in Quality Management
- 1 year of experience in provider relations and education
- Must reside in WI or in a bordering state
- 1 year of experience developing surveys and audit tools (preferred)
- Experience in program development (preferred)
- Experience engaging primary care providers such as hospitals, physicians, behavioral health practitioners (preferred)
- Minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
Benefits
Comp & perks- Bonus incentive plan based upon company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Home-based work arrangement
- Dedicated home workspace and internet requirements to support remote work
- Occasional travel to Humana offices for training or meetings