Director, HEDIS Standards and Strategic Enablement

Humana

1d • Remote

About The Position

Become a part of our caring community and help us put health first The Director, Strategy Advancement provides data-based strategic direction to identify and address business issues and opportunities. Provide business intelligence and strategic planning support for business segments or the company at large. The Director, Strategy Advancement requires an in-depth understanding of how organization capabilities interrelate across the function or segment. Location: Remote but strong preference for Louisville, KY Humana's Health Quality and Stars (HQS) is an organization that improves health outcomes and improves the care experience of our members and provider partners through quality solutions. HQS is committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). One key element of this quality rating is the operational execution and performance of the Healthcare Effectiveness Data and Information Set (HEDIS) measures. HQS is seeking the Director of HEDIS Standards and Strategic Enablement to lead a team of qualified professionals responsible for delivering HEDIS results within tightly regulated requirements and timelines and implementing key strategic solutions to advance the operations. As a shared services function, the Director will be responsible for leading and overseeing functions supporting HEDIS quality enablement, HEDIS clinical education and delivery, regulatory compliance, risk management and mitigation, and quality audits and readiness. This position plays a critical role in defining and building strategic frameworks to advance operations and outcomes, and in defining and championing initiatives in support of our vision and strategy. Success will require cultivating and maturing strong relationships with corporate and market teams, being self-directed and highly engaged, and operating with utmost integrity and authenticity.

Requirements

• Bachelor's Degree
• 8 years of experience in healthcare, clinical operations, portfolio coordination and/or consulting
• HEDIS experience and expertise
• Expertise in program administration, planning frameworks and performance tracking
• Experience leading teams, growing talent and leading cross-functionally
• Demonstrated success executing strategic initiatives from planning through delivery, ensuring measurable outcomes
• Experience leading complex cross-functional execution in matrixed environments
• High organizational agility and innovative thinking
• Experience and comfort operating at both strategic and tactical levels
• Strong decision-making skills, particularly with high impact on efficiency, effectiveness, completeness, and accuracy
• Confidence and comfort in conversing with senior management, business leaders and external parties

Nice To Haves

• Exposure to Automated Intelligence (AI) implementations and solutions

Responsibilities

• Provide HEDIS technical specification expertise and consultation – ensuring operations are appropriately governed by specifications and strategic levers are in-play to optimize measure performance
• Lead HEDIS clinical and data integrity audit readiness strategies and continuous monitoring programs to mitigate compliance and regulatory risk
• Lead HEDIS clinical curriculum development and delivery to support medical record review and data file integrity activities
• Own HEDIS standards for measure interpretation, documentation requirements, and compliance guidance
• Own risk management planning related to regulatory submissions, including identification of vulnerabilities and development of mitigation strategies
• Provide senior-level communication and recommendations on compliance risks, quality performance, and improvement opportunities
• Serve as enablement liaison and collaborator across cross-functional teams and operational swim lanes to ensure alignment of quality initiatives and performance goals
• Lead clinical process strategic framework development to support consistent and high-quality HEDIS data collection and submission
• Advise and influence team strategy, supporting initiatives, and long-term roadmap; including supporting strategic exploration efforts by shaping pilots, defining success criteria, and guiding execution paths
• Lead large-scale, high-impact strategic initiatives to optimize operational efficiencies and performance outcomes
• Accelerate shared accountability for continuous improvement by ensuring partner transparency, creating alignment, inspiring action, and delivering tangible results
• Foster a culture of quality, accountability, and continuous improvement across quality functions

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director