Location: Remote but strong preference for Louisville, KY
Humana's Health Quality and Stars (HQS) is an organization that improves health outcomes and improves the care experience of our members and provider partners through quality solutions. HQS is committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). One key element of this quality rating is the operational execution and performance of the Healthcare Effectiveness Data and Information Set (HEDIS) measures.
HQS is seeking the Director of HEDIS Standards and Strategic Enablement to lead a team of qualified professionals responsible for delivering HEDIS results within tightly regulated requirements and timelines and implementing key strategic solutions to advance the operations. As a shared services function, the Director will be responsible for leading and overseeing functions supporting HEDIS quality enablement, HEDIS clinical education and delivery, regulatory compliance, risk management and mitigation, and quality audits and readiness. This position plays a critical role in defining and building strategic frameworks to advance operations and outcomes, and in defining and championing initiatives in support of our vision and strategy. Success will require cultivating and maturing strong relationships with corporate and market teams, being self-directed and highly engaged, and operating with utmost integrity and authenticity.
KEY RESPONSIBILITIES
Provide HEDIS technical specification expertise and consultation – ensuring operations are appropriately governed by specifications and strategic levers are in-play to optimize measure performance
Lead HEDIS clinical and data integrity audit readiness strategies and continuous monitoring programs to mitigate compliance and regulatory risk
Lead HEDIS clinical curriculum development and delivery to support medical record review and data file integrity activities
Own HEDIS standards for measure interpretation, documentation requirements, and compliance guidance
Own risk management planning related to regulatory submissions, including identification of vulnerabilities and development of mitigation strategies
Provide senior-level communication and recommendations on compliance risks, quality performance, and improvement opportunities
Serve as enablement liaison and collaborator across cross-functional teams and operational swim lanes to ensure alignment of quality initiatives and performance goals
Lead clinical process strategic framework development to support consistent and high-quality HEDIS data collection and submission
Advise and influence team strategy, supporting initiatives, and long-term roadmap; including supporting strategic exploration efforts by shaping pilots, defining success criteria, and guiding execution paths
Lead large-scale, high-impact strategic initiatives to optimize operational efficiencies and performance outcomes
Accelerate shared accountability for continuous improvement by ensuring partner transparency, creating alignment, inspiring action, and delivering tangible results
Foster a culture of quality, accountability, and continuous improvement across quality functions
Required Qualifications
Bachelor's Degree
8 years of experience in healthcare, clinical operations, portfolio coordination and/or consulting
HEDIS experience and expertise
Expertise in program administration, planning frameworks and performance tracking
Experience leading teams, growing talent and leading cross-functionally
Demonstrated success executing strategic initiatives from planning through delivery, ensuring measurable outcomes
Experience leading complex cross-functional execution in matrixed environments
High organizational agility and innovative thinking
Experience and comfort operating at both strategic and tactical levels
Strong decision-making skills, particularly with high impact on efficiency, effectiveness, completeness, and accuracy
Confidence and comfort in conversing with senior management, business leaders and external parties
Preferred Qualifications
Exposure to Automated Intelligence (AI) implementations and solutions
Additional Information
You will report to an AVP.
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees 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 employees 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.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay 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.
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.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.