Description
Humana’s Health Quality and Stars organization is seeking a Senior HEDIS Data Manager to deliver quality and value in a fast-paced, dynamic environment to support our Medicare Stars and Medicaid programs through engaging in the transformation of clinical data to inform operational and strategic decision making, collaboration with partners across the enterprise and support of the HEDIS program and related activities. This will require building and maintaining strong relationships with corporate and market teams, including IT, Quality Operations and Compliance, and vended partners.
Responsibilities
The HEDIS Senior Data Manager is accountable for engaging in and supporting all aspects of the HEDIS program and regulatory operations, including vendor oversight, process development, system and technical configurations, and management of efforts to maximize HEDIS results. The HEDIS Senior Data Manager champions a collaborative environment where the team and connected partners align on appropriate strategies for each successful season, ensuring all regulatory submissions of data collection and reporting are accurate, complete and timely. This position requires demonstration of a high level of business acumen as well as cultivating and maturing partnerships within the enterprise.
Through individual and team contributions, the HEDIS Senior Data Manager is responsible for the following:
- Become an expert in HEDIS, Stars, and Medicaid specifications, processes, and schedules
- Drive internal and external partnerships to coordinate, guide, and oversee implementation of clinical measures, as well as all related regulatory activities and reporting
- Interpretation of complicated and large data sets to identify trends, data scenarios, and opportunities for improved member health and measure compliance
- Ability to decipher regulatory literature and effectively communicate impacts and changes
- Apply critical thinking skills to develop queries, isolate impacts of regulatory changes, and identify patterns in clinical data using Excel, SQL, SAS, etc.
- Analyze data to solve a wide variety of business problems and creation of data visualizations that drive strategic vison
- Partnership with IT and HEDIS NCQA-certified vendor on tool and reporting enhancements
- Development, tracking and presentation of HEDIS, Stars, and Medicaid programs, metrics and reporting
- Establish and maintain effective professional relationships with key upstream and downstream partners
- Ensure data quality, timeliness and accuracy
- Champion improvements to existing processes
Required Qualifications
- Proficiency in compiling, analyzing, and interpreting data trends and working with large data sets
- Advanced proficiency in Excel, SQL, SAS, or other data systems
- Superb communication skills (written and verbal) to effectively communicate across teams, levels and functions
- Strong organizational and time management skills
- Self-starter – comfortable working independently to accomplish components of a larger program
- Demonstrated excellence in problem solving/critical thinking with exceptional attention to detail
- Ability to manage multiple simultaneous time-sensitive deliverables
- Strong consultative and collaborative skills working with a variety of teams and internal/external partners
Preferred Qualifications
- Bachelor’s Degree
- Project management experience
- HEDIS Experience
- Experience in the healthcare, insurance or related industry
- Process proficiency with ability to develop new end-to-end processes and effectively optimize existing work processes to predict, address and resolve efficiency and accuracy constraints
Additional Information
Work Style: Hybrid (Office/Remote) or fully Remote
Work Location: We are seeking a candidate with the ability to work out of the Humana Tower office in Louisville, KY but we are also open to fully remote candidates outside of the state of Kentucky
Work at Home/Remote Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
ALERT: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
This is a remote position
#LI-Remote
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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$95,300 – $131,225 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.