Senior Quality Improvement Professional (HEDIS)

Humana Inc; Northern (KY); Hybrid; USD 78,000 - 108,000; Full time

Job summary

Humana Inc. is seeking a Senior Quality Improvement Professional to drive Medicaid clinical quality performance in Kentucky and nationwide. The role analyzes processes, leads PIPs, and collaborates with stakeholders to improve HEDIS measures and overall quality.

You will facilitate quality committees, develop QI plans, and ensure compliance with state and CMS requirements while promoting a culture of continuous improvement across the Humana Healthy Horizons network. Remote nationwide opportunity.

Qualifications

• Active RN license required.
• 3+ years Medicaid and/or Medicare programs experience.
• 3+ years working with state agencies or CMS.

Responsibilities

• Lead quality improvement projects and monitor performance metrics.
• Develop and implement PIPs in collaboration with partners.
• Facilitate quality committees and cross-functional discussions.

Skills

Strong analytical skills

Problem solving

Microsoft Office

Communication skills

Independent / self-directed

Education

RN license

Tools

HEDIS data abstraction tools

Job description

## Senior Quality Improvement Professional (HEDIS)Apply: Remote Nationwide: Full time: Posted Today: R-427945# **Become a part of our caring community**The Senior Quality Improvement Professional will focus organizational efforts on improving Kentucky Medicaid clinical quality performance measures to achieve optimal performance and quality for the Humana Healthy Horizons in Kentucky Medicaid Plan. Plans, performs, and implements cross-functional initiatives, analyzes and measures the effectiveness of existing business processes, and develops sustainable, repeatable, and quantifiable quality and process improvements. Works closely with the Quality Improvement and market leaders to promote an organization-wide culture of quality improvement. The Senior Quality Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.The Senior Quality Improvement Professional uses data to develop and lead quality improvement projects and monitors performance metrics for KY Medicaid.**This includes, but is not limited to:*** Updates, manages, and complies the QI requirement documentation (QI Program Description, QI Work Plans, and QI Evaluation)* Develops, implements, and evaluates activities of state required Performance Improvement Projects (PIPs) in collaboration with internal and external partners* Facilitates/participates in quality committees and quality improvement related meetings and discussion with internal and external partners* Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.* Develops strategy to improve Performance Measures as identified by the state.* Assesses drivers for low performing measures* Develops interventions to improve Performance Measure rates* Assesses need for member and provider collateral information (i.e. HEDIS tip sheets, other support pieces – i.e. provider web based training) and develops collateral documentation needed* Works with analyst to develop Performance Measure view for performance measures and identify those practices who potentially need assistance with performance measures (i.e. HEDIS measure analysis)* Leads and participates in QI activities designed to improve performance measures* Collaborates with member and provider facing teams to drive QI activities* Subject Matter Expert for all member and provider quality and performance measures content for documents like the Enrollee Newsletter, Provider Manual, and quality documents* Strong relationship building skills* Excellent written and oral communication skills* Ability to work independently under general instructions, must be self-directed and motivated.# **Use your skills to make an impact****Required Qualifications*** Active, unrestricted Registered Nurse (RN) license.* 3+ years' experience working with **Medicaid** and/or **Medicare** programs and regulations.* 3+ years' experience collaborating with **state agencies** or the **Centers for Medicare & Medicaid Services** (CMS).* 3+ year experience leading or supporting **Quality Improvement and Performance Improvement projects**.* 3+ years of direct experience and knowledge of **healthcare quality measurement programs**, including HEDIS, Star Ratings, and related **performance metrics**.* 1+ year of experience with **HEDIS** supplemental and/or **hybrid data abstraction**, **medical record review**, and **quality audit activities**.* Proficiency with Microsoft Office applications, including **Word, Excel,** and **PowerPoint**.* Strong analytical and problem-solving skills with the ability to **interpret data and identify trends**.**Preferred Qualifications:*** Experience working with **Kentucky Medicaid** programs and regulations.* Knowledge of Humana organizational policies, procedures, and operational systems.**Additional Information*** **Schedule/Time Zone:** Monday through Friday, 8:00 AM to 5:00 PM Eastern Time, with flexibility to work overtime as needed.* **Work Location:** Nationwide (U.S.)* **Work Style:** Remote* **Travel Requirements:** Travel to Humana's Kentucky office up to **four times** per year for meetings and training.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 yearThis 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.Application Deadline: 09-17-2026