Humana · 9 hours ago
Director, Clinical Quality Improvement
Tampa, FL
Full-time
Hybrid
Mid, Senior Level
$126K/yr - $174K/yr
5+ years expHumana is committed to putting health first and is seeking a Director of Clinical Quality Improvement to provide strategic leadership for their Florida Medicaid Quality Program. This role involves overseeing quality and compliance processes, managing quality improvement projects, and collaborating with various teams to enhance health outcomes and reduce disparities.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Operate an NCQA compliant quality program
Manage, develop and coach 2 direct and 20 indirect reports
Oversee the development, implementation and management of quality improvement projects and work collaboratively to address health equity and social determinants of health
Partner with the CMO and Population Health Director to inform population health strategy and target improvement areas including the design of clinical programs that improve health outcomes and reduce health disparities
Oversee HEDIS and CAHPS required measure reporting, evaluation, and improvement
Ensure compliance with quality-of-care investigations and reporting
Provide oversight of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation
Improve quality measure performance through innovative approaches in engaging members and providers
Oversee the medical record and treatment record review processes for the plan
Analyze dashboards consisting of Key Performance Indicators (KPI), and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes
Incorporate actionable analytics, utilizing business intelligence tools, care coordination tools, and claims systems to identify issues, mitigate risks, and develop solutions
Serve on standing committees of governance and quality management
Responsible for maintaining confidential information in accordance with policies, and state and federal laws, rules and regulations regarding confidentiality
Maintaining/Updating policies and procedures and program descriptions
Qualification
Required
FL RN License or equivalent clinical license such as APRN
Must reside in the state of Florida
5 or more years of clinical and management experience
3 or more years of quality improvement experience in Medicaid or Medicare (Medicaid quality improvement a plus) (i.e. HEDIS, CMS Stars)
Travel within the FL area up to 25% of the time
Prior experience in a fast-paced insurance or health care setting
Experience in provider relations and education
Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
Proven analytical skills
Excellent communication skills, both oral and written
Strong relationship building skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred
Bachelor's degree in Nursing and/or Advanced Degree
Knowledge of Humana's internal policies, procedures and systems
Benefits
Health benefits effective day 1
Paid time off, holidays, volunteer time and jury duty pay
Recognition pay
401(k) retirement savings plan with employer match
Tuition assistance
Scholarships for eligible dependents
Parental and caregiver leave
Employee charity matching program
Network Resource Groups (NRGs)
Career development opportunities
Medical, dental and vision benefits
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Caleb Gallifant
Chief Operating Officer, CenterWell Home Health
Recent News
2026-01-16
2026-01-16
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