Quality Improvement - Incidents
Listed on 2026-02-01
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Healthcare
Healthcare Management, Healthcare Administration
Overview
Become a part of our caring community and help us put health first
Humana is seeking a Quality Improvement Professional to join the Wisconsin Medicaid Market team. The Quality Improvement Professional monitors incident investigations and compliance processes; manages the incident management system and processes, department SharePoint, and department reporting; audits processes as needed for compliance; completes and submits reports to state regulators as required.
ResponsibilitiesImplement quality improvement initiatives related to incident management.
Manage the Incident Management System (IMS) that connects to the state reporting system.
Review, triage, and process incident reports, quality alerts, and program integrity events applying critical thinking skills to ensure sufficient detail and appropriate follow up and regulatory compliance.
Act as a resource to Care Management by providing guidance and education around incident investigation and follow up.
Collaborate with Quality Management Leadership and other Departments to ensure appropriate response to immediate member risk or concerns.
Assist with the collection, organization, and evaluation of data from incidents, events, quality alerts, and statements of deficiency as a means to identify and address systemic quality concerns.
Ensure opportunities for stakeholder involvement in activities aimed at supporting quality through the monitoring of incidents and events.
Bachelor's degree or higher in the human services area (Social work, Sociology, Psychology or Nursing) with a minimum of one year experience working with elders, adults with physical disabilities or adults with intellectual disabilities OR a bachelor’s degree in any field with a minimum of 3 years experience working with elders, adults with physical disabilities or adults with intellectual disabilities.
3 years' experience in a health insurance, health care, or long-term services and support setting.
Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint.
Experience in WI long-term care programs, Family Care or Family Care Partnership, providing care management support to elders and/or adults with physical or intellectual disabilities.
Experience in data collection, analysis, and reporting.
Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
Work Location: must reside in Wisconsin.
Travel: This opportunity requires minimal travel within Wisconsin.
Typical Work days/hours: Monday – Friday, 8:00 am – 5:00 pm Central Standard Time (CST)
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
About Inclusa:
Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved.
In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.
About Humana
:
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana…
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