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The Delaware Valley ACO (DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP). DVACO is a joint venture among three stakeholders: Humana, Main Line Health System, and Jefferson Health System. Humana takes the lead in providing administrative support in various areas including HR.

DVACO's MSSP participation accounts for the region's largest Medicare ACO grouping, with more than 2,000 physicians and approximately 70,000 Medicare fee-for-service beneficiaries. Additionally, DVACO currently holds performance-based contracts with private payers and manages population health initiatives for the employees and dependents of Jefferson Health and Main Line Health, enhancing DVACO's total number of beneficiaries to over 200,000.

DVACO' s primary focus is outlined by the three-part aim:

Improve the Health of our Patient Population

Improve our Patients' Experiences

Reduce the per-capita Cost of Care delivered to our Population

These goals are achieved through enhanced coordination of patient care and by dedication to quality improvement initiatives that increase the efficiency of care delivery within the outpatient setting

The Quality Improvement Lead leads the organization's quality improvement program strategy and deployment for all DVACO contracts. The Quality Improvement Lead serves as the subject matter quality expert to support VP Payor Relations and CFO in payor contract development/negotiation of contractual quality measures and targets. Via established committee structures this position is responsible to drive alignment with Jefferson Health (JH) and Main Line Health (MLH) quality and clinical leadership on quality measures, targets, analysis, improvement activities, and targeted campaigns.

The Quality Improvement Lead is responsible to provide all relevant parties with the quality performance information necessary to facilitate informed decisions by Payor Partnership, Clinical Integration, and/or Audit Finance Committees to make recommendations about payor contracting to the Board of Directors. This position serves as the quality lead of the DVACO to payors, health-system leadership, Humana, and the community. The position drives quality improvement through a data-driven approach with assessment of performance, prioritization of quality improvement initiatives for all quality measures including but not limited to utilization measures of quality, HEDIS measures, Medicare Stars performance, electronic clinical quality measures (eCQMs), and patient experience measures. Leads quality submission requirements for the Medicare Shared Savings Program. Leads and or supports all compliance actions, requirements, needs related to quality for the enterprise.

Leads a small team

Creates and executes a comprehensive Quality Improvement Management program for DVACO

Ensures close collaboration with practice transformation, care coordination, and care continuum departments to optimize resource utilization and minimize duplication of effort related to synergistic workflows

Designs and implements quality improvement initiatives to reduce avoidable emergency room utilization, admissions, and readmissions for all payer programs

Evaluates effectiveness of quality improvement initiatives using benchmark and objective data, including but not limited to, member health outcomes, satisfaction survey results (CAHPS), utilization metrics, HEDIS performance, and Medicare Star ratings

Chairs the Quality Oversight Advisory and Quality Oversight Committees

In collaboration with JH and MLH Quality Leadership, directs and oversees enterprise-wide efforts to ensure that DVACO quality programs meet or exceed performance standards and requirements of federal or state regulations

Identifies opportunities to streamline workflows that result in accurate, high quality productivity standards and improved results in cost savings, or outcomes measurement

Leads organizational quality reporting efforts for multiple health insurance organizations

Evaluates quality management practices and oversees implementation of corrective actions as appropriate

Establishes process management and documentation requirements at the enterprise level

Establishes strategic direction of quality program and facilitates setting of measurable strategic goals

Serves as a member of the clinical team and participates in strategic planning at the enterprise level

Establishes and maintains the quality improvement operating budget

Responsible for the hiring, oversight, and management of Quality staff members

Provides the clinical expertise to analytics and operations teams to design, redesign, ensure accuracy, and overall maintenance of enterprise Quality Improvement Dashboard

Primary Customers or Key Working Relationships:

All DVACO Teams,

DVACO Participating Physicians

'POD'/CIN Leadership/Management teams

All DVACO Committee and board members

Payor Partners

Post-Acute/Care Continuum Care Partners

DVACO General Counsel

In addition to being a great place to work, Humana/DVACO also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

Medical Benefits

Dental Benefits

Vision Benefits

Health Savings Accounts

Flex Spending Accounts

Life Insurance

401(k)

PTO including 8 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time

And more

Use your skills to make an impact

Required Qualifications

Bachelor's degree

Clinical Degree in designated state in good standing ie. RN, OT, PT, SL/P, PharmD

7+ years' Quality Improvement Experience with broad knowledge and experience in healthcare and quality improvement initiatives including management of utilization quality metrics

Experience with Medicare health care regulatory reporting and compliance activities

Demonstrated understanding of and experience improving Medicare STARs Quality measures

Experience driving quality improvement activities related to avoidable emergency room utilization, inpatient admission utilization, and readmissions

Project Management and Process Improvement training and experience

Strong computer skills with proficiency Microsoft products such as Word, Excel, PowerPoint, SharePoint, PowerBI, and Planner

Excellent verbal, written, and facilitation skills along with a sound understanding of business principles, operations, strategies

Highly motivated, self-starter with strong leadership, change management, planning, organizational and project management skills with experience managing complex and cross-functional initiatives

Excellent interpersonal skills and ability to manage many activities in a fast-paced environment

Ability to develop positive interaction with health system leadership, physicians, and teammates to effectively promote care for the patient

Aptitude for coaching, training, and developing new teammates.

Able to work long hours with erratic schedule including early morning and evening meetings as needed

Able to work and lead people in a remote environment

Exhibits behaviors consistent with DVACO's mission and core values

Preferred Qualifications

Master's Degree

Experience in primary care

CPHQ, CHQ or HCQM, NCQA, AHRQ, ISO experience ​

​ Additional Information

Work at Home/Remote Requirements

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.

Wireless, Wired Cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)

Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-LM1

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$93,000 - $128,000 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, 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 and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.