Senior Quality Improvement Professional

Humana•Carolina, SC

11d•Remote

About The Position

The Senior Quality Improvement Professional leads provider-focused, cross-functional initiatives to improve clinical quality, provider performance, and member experience for Humana Healthy Horizons in South Carolina Medicaid Plan. The role develops and implements quality improvement initiatives, evaluates business processes and performance outcomes, and drives sustainable, measurable improvements. Reporting to the Quality Improvement Director, this position collaborates with internal and external stakeholders and provider-facing teams, uses healthcare data to identify opportunities and inform strategy, and supports provider performance enhancement. It also leads and participates in multidisciplinary committees, provides strategic clinical guidance, and influences business decisions through data-driven insights. The position operates with a high degree of independence and manages complex projects. This is a remote work-from-home position for someone who resides within two hours of Columbia, South Carolina, with occasional business travel to Columbia. The schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m. Eastern Time, with 5–10% travel and 40 scheduled weekly hours. The posted annual base pay range is $78,400–$107,800. The position is eligible for a bonus incentive plan.

Requirements

Bachelor's degree.
Must reside in South Carolina.
At least 3 years of healthcare quality improvement experience, including HEDIS, CAHPS, or related performance measures.
At least 2 years of provider-facing experience supporting quality and performance improvement initiatives.
Managed care experience; South Carolina Medicaid experience is preferred.
Experience analyzing and interpreting healthcare performance data, translating findings into actionable improvement plans, and evaluating intervention results.
Proficiency in Excel and experience using reporting or visualization tools to analyze and communicate performance trends.
Strong communication, relationship-building, and stakeholder engagement skills.
Ability to work independently, manage multiple priorities, and execute strategic initiatives with measurable objectives and timelines.

Nice To Haves

Advanced degree.
Project management experience leading complex or high-impact initiatives.
Knowledge of South Carolina Medicaid Managed Care requirements.
Experience applying structured quality improvement methodologies, such as Plan-Do-Study-Act.
Certified Professional in Healthcare Quality (CPHQ) or a related quality improvement certification.
Experience with provider practice workflows, care-gap closure, and clinical data exchange.

Responsibilities

Partner with Provider Engagement, Network, and Contracting teams to implement clinical quality improvement strategies, including education, performance reporting, and workflow improvements that address care gaps and advance quality and member experience goals.
Analyze provider-level performance data and other healthcare data sources to identify improvement opportunities, prioritize care gaps, and translate findings into actionable recommendations and targeted interventions.
Lead and participate in cross-functional quality improvement workgroups aimed at improving HEDIS, CAHPS, and other performance measures, with clear action plans and follow-through.
Collaborate with internal and external stakeholders to advance quality and strengthen member outreach and care-gap closure efforts.
Lead provider-focused strategies supporting CAHPS/ECHO and other member experience initiatives.
Maintain documentation of improvement plans, interventions, outcomes, and corrective actions for quality reporting, audits, and oversight activities.
Manage complex projects and use data-driven insights to support organizational objectives and provider performance improvement.