Director, Data Quality & Integrity (Provider Network Operations)

Humana

3d•$156,600 - $215,400•Remote

About The Position

The Director, Data Quality & Integrity defines and executes the enterprise strategy for provider data quality, governance, directory accuracy, and innovation. The role establishes operating models, standards, controls, and continuous improvement practices to ensure provider data is accurate, complete, timely, compliant, and trusted across provider directories, network operations, credentialing, contracting, and digital experiences. Reporting to the VP of Provider Network Operations, the Director partners with Operations, Technology, Analytics, Compliance, Provider Services, market leadership, and external vendors. The role leads enterprise data governance and mastering initiatives, data auditing and controls, provider directory quality and CMS compliance efforts, process improvement, technology and vendor assessments, and organizational change. The position is remote, with occasional travel to Humana offices for training or meetings. Work requires a dedicated space to protect member PHI/HIPAA information and home internet service meeting the stated minimum speeds.

Requirements

Bachelor's degree in Business, Healthcare Administration, Information Systems, Data Analytics, or a related field.
At least 8 years of leadership experience in provider data management, provider directory operations, data governance, data quality, network operations, or related healthcare functions.
Deep understanding of provider data domains, including directory data, demographics, affiliations, specialties, credentialing, contracting, and regulatory requirements.
Experience designing and implementing enterprise data governance frameworks, stewardship models, quality controls, and auditing programs.
Proven success leading large-scale cross-functional transformation initiatives across business and technology organizations.
Strong executive presence and ability to influence stakeholders and translate complex data issues into business outcomes.
For home work, self-provided internet service must have at least 25 Mbps download and 10 Mbps upload; wireless, wired cable, or DSL is suggested.
Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.
This role is not eligible for work visa sponsorship.

Nice To Haves

Master's degree in a related field.
Experience with provider directory accuracy programs, regulatory audits, accreditation requirements, and provider network operations.
Experience with master data management, data governance platforms, and data quality tools.
Lean, Six Sigma, Data Governance, or Data Management certifications.

Responsibilities

Develop and execute a multi-year data quality and integrity strategy aligned with organizational priorities.
Establish enterprise standards, policies, and operating models for sustainable data quality practices.
Lead strategic initiatives to improve data accuracy, completeness, consistency, and timeliness.
Provide thought leadership in data quality management, governance, and stewardship.
Lead governance programs defining ownership, accountability, business rules, and quality standards for critical data assets.
Establish data stewardship responsibilities and governance processes with business and technology leaders.
Oversee data mastering initiatives, including identifying, defining, and managing key enterprise data assets.
Align stakeholders on data definitions, standards, and quality expectations.
Design and implement data-driven auditing programs to identify anomalies, risks, and process weaknesses.
Establish monitoring frameworks and controls to improve visibility into data quality performance.
Lead reconciliation and validation processes across multiple data sources.
Develop feedback mechanisms and continuous improvement processes to address root causes of data quality issues.
Assess end-to-end business processes that affect data quality and integrity.
Lead provider directory data quality and integrity efforts to meet CMS requirements for accuracy, completeness, timely updates, and audit readiness.
Identify rework drivers, inefficiencies, and recurring quality issues and implement sustainable solutions.
Lead continuous improvement initiatives to improve operational effectiveness and reduce data-related defects.
Develop executive dashboards and reporting with actionable quality performance insights.
Evaluate current and emerging data quality technologies and governance solutions.
Lead vendor assessments, RFP processes, and business case development for new capabilities.
Partner with Technology teams to implement tools for automation, monitoring, and data governance.
Assess market-leading practices and identify opportunities to improve quality management capabilities.
Build relationships with operational leaders, technology teams, analytics partners, and external vendors.
Facilitate cross-functional alignment on data quality priorities and governance decisions.
Present findings, recommendations, and strategic roadmaps to executive leadership.
Lead organizational change efforts that promote enterprise ownership of data quality.
Occasionally travel to Humana offices for training or meetings.