Senior HEDIS Data Manager

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
• 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
• Bachelor's Degree or equivalent experience

Preferred Qualifications

• Master's Degree
• Project management experience
• HEDIS and/or Medicaid Experience
• Advanced proficiency in Excel, SQL, SAS, or other data systems

Additional Information

This position is open to working at the Humana Tower facility in Louisville, Kentucky with work at home opportunities in Kentucky

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Covid Policy

• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40