Director, HEDIS Standards – Strategic Enablement
Humana
full-time
Posted on:
Location Type: Remote
Location: Kentucky • United States
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Salary
💰 $168,000 - $231,000 per year
Job Level
About the role
- 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
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.
Benefits
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
HEDIS expertiseprogram administrationperformance trackingclinical curriculum developmentdata integrity auditrisk management planningstrategic framework developmentstrategic initiative executioncompliance guidancemeasure interpretation
Soft Skills
leadershiporganizational agilityinnovative thinkingdecision-makingcommunicationcollaborationinfluencingaccountabilitycontinuous improvementstrategic thinking
Certifications
Bachelor's Degree