Senior Quality Improvement Lead – HEDIS (Medicaid, Remote)

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

Job summary

Humana Inc. seeks a Senior Quality Improvement Professional to lead Kentucky Medicaid quality performance initiatives and strengthen the Humana Healthy Horizons program.

You will manage cross-functional QI projects, develop measurable improvement plans, and ensure documentation compliance (QI Program Descriptions, Work Plans, Evaluations). Remote with periodic travel to Kentucky; strong data analytics required.

Qualifications

• Active, unrestricted RN license.
• 3+ years with Medicaid/Medicare programs and regulations.
• 3+ years collaborating with state agencies or the Centers for Medicare & Medicaid Services (CMS).
• 3+ years leading or supporting Quality Improvement projects.
• 3+ years knowledge of healthcare quality measurement programs (HEDIS, Star Ratings).
• 1+ year of HEDIS supplemental/hybrid data abstraction and medical record review.
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint).
• Strong analytical and problem-solving skills with data interpretation.

Responsibilities

• Plan, perform, and implement cross-functional QI initiatives.
• Analyze and measure the effectiveness of existing processes.
• Develop sustainable, repeatable quality improvements and QI documentation.
• Lead Performance Improvement Projects for KY Medicaid.
• Facilitate quality committees and related meetings with internal/external partners.
• Collaborate with member/provider teams to drive QI activities.

Skills

Quality improvement

Data analysis

Cross-functional collaboration

Project management

Communication

Healthcare regulations

Education

RN license

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Humana Inc. seeks a Senior Quality Improvement Professional to lead Kentucky Medicaid quality performance initiatives and strengthen the Humana Healthy Horizons program.

You will manage cross-functional QI projects, develop measurable improvement plans, and ensure documentation compliance (QI Program Descriptions, Work Plans, Evaluations). Remote with periodic travel to Kentucky; strong data analytics required.