HEDIS & Stars Measure Optimization Lead

Humana; Frankfort (KY); In loco; USD 118.000 - 162.000; Tempo pieno

Descrizione del lavoro

Humana in Kentucky is seeking a Measure Optimization Lead – CC to drive HEDIS Care Coordination performance. You will lead cross-functional initiatives, translate insights into actionable recommendations, and partner with clinical, operations, analytics, and vendor teams to improve member care and plan quality.

Responsibilities include strategic leadership, preparing materials for senior leadership, and defining reporting requirements.

Competenze

• Bachelor’s degree.
• 7 or more years of experience in data analysis and/or business intelligence.
• 3 or more years of experience with Medicare Advantage, Stars programs, HEDIS measures, or healthcare quality improvement.
• Strong understanding of CMS Star Ratings.
• Experience with business intelligence tools such as Power BI, Tableau, Qlik, SQL, or similar platforms.
• Experience defining business questions and requirements for analytical and technical partners.
• Ability to interpret reporting and analytical findings, identify root causes and performance drivers, and translate insights into practical recommendations.
• Proven ability to work across business, clinical, operational, technology, analytics, and vendor teams.
• Experience leading complex initiatives, managing accountability, resolving issues, and influencing outcomes without direct authority.
• Excellent communication and presentation skills, with the ability to convey complex concepts clearly to senior leadership.

Mansioni

• Lead the HEDIS Care Coordination measure optimization strategy and identify opportunities to improve performance.
• Evaluate business and operational factors affecting measure outcomes and recommend targeted improvements.
• Translate measure requirements, performance insights, and business needs into clear priorities and implementation plans.
• Prepare high-quality materials and recommendations for vice presidents and senior leadership discussions.
• Participate in strategic conversations, providing actionable insights and clear recommendations.
• Communicate complex HEDIS, operational, and performance concepts in a clear and compelling manner to non-technical audiences.
• Collaborate with quality improvement, clinical, operations, technology, analytics, and vendor teams to assess and enhance Care Coordination measure performance.
• Lead initiatives from opportunity identification and business requirements through implementation and continuous improvement.
• Identify and resolve business and operational barriers affecting workflows, supplemental data pathways, source connectivity, and ownership.
• Act as a HEDIS subject matter expert, explaining measure requirements, methodology, and performance implications.
• Partner with analytics teams to frame business questions, interpret approved analyses, and translate findings into practical recommendations.
• Define business reporting requirements and success measures for Care Coordination initiatives.
• Use established dashboards and reporting to communicate key metrics, trends, risks, and improvement opportunities.
• Promote accuracy, consistency, and clarity in business materials and executive communications.

Conoscenze

Data analysis

Business intelligence

CMS Star Ratings understanding

Communication skills

Cross-functional collaboration

Analytical thinking

Formazione

Bachelor's degree

Strumenti

Power BI

Tableau

Qlik

SQL

Descrizione del lavoro

Humana in Kentucky is seeking a Measure Optimization Lead – CC to drive HEDIS Care Coordination performance. You will lead cross-functional initiatives, translate insights into actionable recommendations, and partner with clinical, operations, analytics, and vendor teams to improve member care and plan quality.

Responsibilities include strategic leadership, preparing materials for senior leadership, and defining reporting requirements.