Remote Senior Quality Improvement Lead for HEDIS/Medicaid

Humana Inc; Salem (OR); Remote; USD 78,000 - 108,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Senior Quality Improvement Professional to focus on Kentucky Medicaid clinical quality performance and improve measures across the program.

You will lead cross-functional quality initiatives, analyze performance data, and develop scalable improvements with internal and external partners to promote a culture of quality. The role requires RN licensure and 3+ years in Medicaid/Medicare quality programs, with strong data interpretation skills and experience in HEDIS and

Qualifications

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

Responsibilities

• Update, manage, and comply QI documentation (QI Program Description, Work Plans, Evaluation).
• Develop, implement, and evaluate state required Performance Improvement Projects (PIPs).
• Lead/participate in quality committees and meetings with internal/external partners.
• Align QA strategy with department and organizational objectives; link to related areas.
• Improve Performance Measures as identified by the state.
• Identify drivers for low performance measures and develop interventions.
• Determine need for member/provider collateral and develop materials.
• Collaborate with analysts to develop Performance Measure views and target practices needing support.
• Lead QI activities to improve performance measures and collaborate with member/provider teams.
• Serve as SME for member/provider quality content in newsletters, manuals, and documents.
• Build strong relationships and communicate clearly; work independently.

Skills

RN license

Medicaid/Medicare programs

state agencies/CMS

Quality Improvement

Healthcare quality metrics

HEDIS / data abstraction

Microsoft Office (Word, Excel, PowerPt

Analytical thinking

Tools

Word

Excel

PowerPoint

Job description

Humana Inc. is seeking a Senior Quality Improvement Professional to focus on Kentucky Medicaid clinical quality performance and improve measures across the program.

You will lead cross-functional quality initiatives, analyze performance data, and develop scalable improvements with internal and external partners to promote a culture of quality. The role requires RN licensure and 3+ years in Medicaid/Medicare quality programs, with strong data interpretation skills and experience in HEDIS and