Remote Quality Improvement Leader for Medicaid

Humana; South Carolina; On-site; USD 78,000 - 108,000; Full time

Benefits offered by this job

Remote work at home

Bonus incentive plan

Competitive benefits

Job summary

Humana Senior Quality Improvement Professional is responsible for leading clinical quality and provider performance improvements for Humana Healthy Horizons in South Carolina Medicaid. Develop cross-functional quality initiatives, evaluate processes, and drive measurable outcomes.

Reporting to the Quality Improvement Director, you will analyze diverse data sources, collaborate with provider-facing teams, and influence business decisions through data-driven insights.

Qualifications

• Bachelor's degree is required.
• SC residency required.
• 3+ years healthcare quality improvement experience (HEDIS/CAHPS).
• 2+ years provider-facing experience in quality and performance improvement.
• Managed care experience, preferably SC Medicaid.
• Experience analyzing healthcare performance data.
• Strong communication and stakeholder engagement skills.
• Ability to work independently and manage multiple priorities.

Responsibilities

• Partner with Provider Engagement, Network, and Contracting teams to implement quality improvement strategies.
• Analyze performance data to identify improvement opportunities and develop interventions.
• Lead cross-functional quality improvement workgroups to improve HEDIS/CAHPS and other measures.
• Collaborate with internal and external stakeholders to advance quality and member experience goals.
• Lead provider-focused strategies supporting CAHPS/ECHO and member experience initiatives.

Skills

Healthcare quality

Data analysis

Stakeholder engagement

Independent working

Education

Bachelor's degree

Job description

Humana Senior Quality Improvement Professional is responsible for leading clinical quality and provider performance improvements for Humana Healthy Horizons in South Carolina Medicaid. Develop cross-functional quality initiatives, evaluate processes, and drive measurable outcomes.

Reporting to the Quality Improvement Director, you will analyze diverse data sources, collaborate with provider-facing teams, and influence business decisions through data-driven insights.