Remote RN: Senior Quality Improvement for Medicaid (HEDIS)

Humana Inc; Topeka (KS); Remote; USD 78,000 - 108,000; Full time

Benefits offered by this job

Bonus incentive plan

Competitive benefits

Job summary

Humana Inc. is seeking a Senior Quality Improvement Professional to lead Kentucky Medicaid clinical quality initiatives across Humana Healthy Horizons in Kentucky.

You will analyze data, develop interventions, and guide cross-functional teams to improve HEDIS and related performance measures. The role requires an RN license and a track record in Medicaid/Medicare programs, with strong communication and analytical skills.

Qualifications

• Active, unrestricted RN license.
• 3+ years' experience with Medicaid and/or Medicare programs.
• 3+ years collaborating with state agencies or CMS.
• 3+ years leading or supporting Quality Improvement projects.
• 3+ years experience with healthcare quality measurement (HEDIS/Star).
• 1+ year in HEDIS supplemental data abstraction and medical record review.
• Proficiency with Word, Excel, and PowerPoint.
• Strong analytical skills to interpret data and identify trends.

Responsibilities

• Plan, perform, and implement cross-functional quality improvement initiatives.
• Develop and monitor Performance Measure improvements for KY Medicaid.
• Lead QI activities and collaborate with internal and external partners.
• Prepare and maintain QI program documentation (program descriptions, work plans, evaluations).
• Partner with provider and member teams to drive QI activities and reporting.

Skills

Analytical skills

Communication skills

Independent / self-directed

Tools

Word

Excel

PowerPoint

Job description

Humana Inc. is seeking a Senior Quality Improvement Professional to lead Kentucky Medicaid clinical quality initiatives across Humana Healthy Horizons in Kentucky.

You will analyze data, develop interventions, and guide cross-functional teams to improve HEDIS and related performance measures. The role requires an RN license and a track record in Medicaid/Medicare programs, with strong communication and analytical skills.