Remote Senior Quality Improvement Leader HEDIS/Medicaid

Humana Inc; Dover (DE); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana Inc. is seeking a Senior Quality Improvement Professional to focus on Kentucky Medicaid clinical quality performance. The role develops, implements, and measures QI initiatives, collaborating with market leaders to promote an organization-wide culture of quality.

The position emphasizes data-driven performance improvement, cross-functional teamwork, and documentation of QI activities. Remote work is available with occasional travel to Kentucky for meetings.

Qualifications

• Active, unrestricted RN license.
• 3+ years' experience with Medicaid and/or Medicare programs and regulations.
• 3+ years' experience collaborating with state agencies or CMS.
• 3+ years' experience leading or supporting Quality Improvement projects.
• 3+ years' experience with healthcare quality measurement programs (HEDIS, Star Ratings, metrics).
• 1+ year experience with HEDIS supplemental data abstraction, medical record review, quality audit activities.

Responsibilities

• Update, manage, and comply with QI documentation (QI Program Description, QI Work Plans, QI Evaluation).
• Develop, implement, and evaluate activities of state-required Performance Improvement Projects (PIPs).
• Facilitate quality committees and meetings with internal and external partners.
• Develop strategy to improve Performance Measures identified by the state.
• Assess drivers for low performing measures and develop interventions.
• Collaborate with member and provider facing teams to drive QI activities.
• Act as SME for member/provider quality and performance measures content in documents.

Skills

Analytical thinking

Problem solving

Communication skills

Relationship building

Independent work

MS Office (Word, Excel, PowerPoint)

Education

Registered Nurse license (RN)

Tools

Microsoft Office

Job description

Humana Inc. is seeking a Senior Quality Improvement Professional to focus on Kentucky Medicaid clinical quality performance. The role develops, implements, and measures QI initiatives, collaborating with market leaders to promote an organization-wide culture of quality.

The position emphasizes data-driven performance improvement, cross-functional teamwork, and documentation of QI activities. Remote work is available with occasional travel to Kentucky for meetings.