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Humana Nationwide Medicaid Behavioral Health Quality Lead in Billings, Montana


The Behavioral Health Quality Lead will report directly to the National Medicaid Quality Director, and be responsible for the development, maintenance, and execution of Humana Healthy Horizon's National Improvement strategy and operating model for Behavioral Health Quality, and its integration with Physical Health Quality, within the Medicaid line of business.


The Behavioral Health Quality Lead exercises independent judgment and decision making on complex issues regarding responsibilities and related tasks, works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action. Responsibilities include:

  • Provide direction and oversight of the Behavioral Health Quality management model and improvement strategy for the Medicaid line of business at the national level, and further the integration of Physical Health and Behavioral Health Quality.

  • Develop policy and procedure, and define/improve processes regarding HEDIS and quality measurement data collection and improvement methodology for all Behavioral Health focused measures.

  • Develop educational materials and strategies to engage practicing Behavioral Health clinicians in improving operational process and clinical care quality in an effort to improve member experiences and health outcomes.

  • Establish and improve care coordination processes between outpatient Behavioral Health practices, hospitals, and primary care physicians.

  • Assist in the development of innovative value based payment models for Behavioral Health provider partners.

  • Drive all Behavioral Health Quality related activities during the implementation of new Medicaid markets.

  • Provide ongoing wrap-around support to market Quality teams for Behavioral Health related issues, process improvement, and clinical initiatives.

  • Drive interdepartmental collaboration to achieve business goals

Required Qualifications

  • Bachelor's degree in Business, Healthcare, or related field.

  • 5+ years of experience managing Behavioral Health Quality programs.

  • 5+ years of experience monitoring and improving behavioral health quality measures (example HEDIS or CAHPS) in a quality operations / quality management or office based practice setting.

  • Demonstrated ability to perform moderate to complex data analysis.

  • Previous experience working with behavioral health providers on quality and performance improvement activities.

  • Strong relationship building skills.

  • Excellent written and oral communication skills.

  • Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel.

  • Ability to work independently under general instructions, must be self-directed and motivated.

  • 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 10x1 (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

  • Clinical Licensure including: Licensed Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPCC), Registered Nurse with behavioral health experience or other related licenses.

  • Certified Professional in Healthcare Quality (CPHQ).

  • Experience with quality improvement methodology such as plan-do-study-act.

  • Advanced degree in business, healthcare, or related field.

  • Project management experience.

  • Strong business acumen.

Additional Information

  • Travel: up to 10%

  • Work Hours: Eastern Standard Time.

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