Senior Quality Improvement Professional

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

Become a part of our caring community The Senior Quality Improvement Professional leads efforts to improve clinical quality and provider performance for the Humana Healthy Horizons in South Carolina Medicaid Plan. You will develop and implement cross-functional quality improvement initiatives, evaluate business processes and performance outcomes, and drive sustainable, measurable improvements.

Become a part of our caring community The Senior Quality Improvement Professional leads efforts to improve clinical quality and provider performance for the Humana Healthy Horizons in South Carolina Medicaid Plan. You will develop and implement cross-functional quality improvement initiatives, evaluate business processes and performance outcomes, and drive sustainable, measurable improvements. Reporting to the Quality Improvement Director, you will collaborate with internal and external stakeholders to advance a provider-focused culture of quality and performance excellence. You will manage complex projects and analyze diverse data sources to identify opportunities, inform strategy, and support organizational objectives. The Senior Quality Improvement Professional leverages data to lead quality improvement initiatives, monitor performance metrics, and support provider performance enhancement. This role collaborates with provider-facing teams to implement targeted interventions, develop educational resources, and drive achievement of quality and member experience goals. The position leads and participates in multidisciplinary committees, provides strategic clinical guidance on quality initiatives, and influences business decisions through data-driven insights. Operating with a high degree of independence, the Senior Quality Improvement Professional manages complex projects, exercises sound judgment, and recommends solutions to advance organizational objectives.

Essential Role Responsibilities

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

Required Qualifications

Use your skills to make an impact

• Bachelor's degree.
• South Carolina residency required.
• 3+ years of healthcare quality improvement experience, including HEDIS, CAHPS, or related performance measures.
• 2+ years of provider-facing experience supporting quality and performance improvement programs.
• Managed care experience, preferably within South Carolina Medicaid.
• Experience analyzing and interpreting healthcare performance data.
• Strong communication, relationship-building, and stakeholder engagement skills.
• Demonstrated ability to work independently, manage multiple priorities, and execute strategic initiatives.

Preferred Qualifications

• Advanced Degree.
• Project management experience leading complex or high-impact initiatives.
• Knowledge of South Carolina Medicaid Managed Care requirements.

Workstyle:

Remote work at Home with occasional travel for business to Columbia SC

Location:

Reside within 2 hours of Columbia SC

Schedule:

Monday through Friday 8:30 AM - 5:00 PM Eastern Time

Travel:

5-10%

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.