Remote Healthcare Quality Improvement Lead

Humana, Inc.; United States; Remote; USD 78,000 - 108,000; Full time

Benefits offered by this job

Bonus incentive plan

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Disability coverage

Job summary

Humana, Inc. is seeking a Senior Quality Improvement Professional to lead provider-focused quality initiatives across the South Carolina Medicaid plan, leveraging data to drive improvements in clinical quality, provider performance, and member experience.

The role requires cross-functional collaboration, management of complex projects, and the ability to translate analytics into actionable interventions with measurable outcomes.

Qualifications

• Bachelor's degree required.
• South Carolina residency required.
• 3+ years of healthcare quality improvement experience, including HEDIS, CAHPS, or related performance measures.
• 2+ years of provider-facing experience supporting quality and performance improvement initiatives.
• Managed care experience, preferably within South Carolina Medicaid.
• Experience analyzing and interpreting healthcare performance data, translating findings into actionable improvement plans, and evaluating intervention results.
• Proficiency in Excel and experience using reporting or visualization tools to analyze and communicate performance trends.
• Strong communication, relationship-building, and stakeholder engagement skills.
• Demonstrated ability to work independently, manage multiple priorities, and execute strategic initiatives with measurable objectives and timelines.

Responsibilities

• Partner with Provider Engagement, Network, and Contracting teams to implement clinical quality improvement strategies including education, performance reporting, and workflow improvements that address care gaps and advance quality and member experience goals.
• Analyze provider-level performance data and diverse healthcare data sources to identify improvement opportunities, prioritize care gaps, and translate findings into actionable recommendations and targeted interventions.
• Lead and participate in cross-functional quality improvement workgroups designed to improve HEDIS, CAHPS, and other performance measures with clear action plans and follow-through.
• Collaborate with internal and external stakeholders to advance quality and strengthen member outreach and care-gap closure efforts.
• Lead provider-focused strategies supporting CAHPS/ECHO and other member experience initiatives.
• Maintain documentation of improvement plans, interventions, outcomes, and corrective actions to support applicable quality reporting, audit, and oversight activities.
• Use your skills to make an impact.

Skills

Communication

Relationship-building

Stakeholder engagement

Excel proficiency

Data visualization

Independent work

Time management

Project management

Education

Bachelor's degree

Advanced degree

Tools

Excel

Job description

Humana, Inc. is seeking a Senior Quality Improvement Professional to lead provider-focused quality initiatives across the South Carolina Medicaid plan, leveraging data to drive improvements in clinical quality, provider performance, and member experience.

The role requires cross-functional collaboration, management of complex projects, and the ability to translate analytics into actionable interventions with measurable outcomes.