Measure Optimization Lead Care Coordination

The Measure Optimization Lead - CC addresses complex business challenges affecting HEDIS Care Coordination measure performance. The role uses established reporting operational knowledge and input from internal and external partners to provide insights and recommendations to decision-makers. The Measure Optimization Lead works across initiatives of diverse scope and complexity ranging from moderate to substantial.

The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings health condition management health outcomes patient experience and plan this pivotal role you will provide HEDIS subject matter expertise and strategic leadership to advance Care Coordination measure performance. You will identify improvement opportunities guide cross-functional initiatives and translate approved reporting and analysis into clear recommendations for leadership. Your work will directly support decision-making and Stars improvement efforts that improve member care strengthen plan quality and advance organizational goals.

Key Responsibilities:

Strategic Leadership

• Lead the HEDIS Care Coordination measure optimization strategy and identify opportunities to improve performance.

• Evaluate business and operational factors affecting measure outcomes and recommend targeted improvements.

• Translate measure requirements performance insights and business needs into clear priorities and implementation plans.

Leadership Support

• Prepare high-quality materials and recommendations for vice presidents and senior leadership discussions.

• Participate in strategic conversations providing actionable insights and clear recommendations.

• Communicate complex HEDIS operational and performance concepts in a clear and compelling manner to non-technical audiences.

Care Coordination Improvement Initiatives

• Collaborate with quality improvement clinical operations technology analytics and vendor teams to assess and enhance Care Coordination measure performance.

• Lead initiatives from opportunity identification and business requirements through implementation and continuous improvement.

• Identify and resolve business and operational barriers affecting workflows supplemental data pathways source connectivity and ownership.

• Act as a HEDIS subject matter expert explaining measure requirements methodology and performance implications.

• Partner with analytics teams to frame business questions interpret approved analyses and translate findings into practical recommendations.

Business Reporting and Communication

• Define business reporting requirements and success measures for Care Coordination initiatives.

• Use established dashboards and reporting to communicate key metrics trends risks and improvement opportunities.

• Promote accuracy consistency and clarity in business materials and executive communications.

Required Qualifications

• Bachelors degree
• 7 or more years of experience in data analysis and/or business intelligence
• 3 or more years of experience with Medicare Advantage Stars programs HEDIS measures or healthcare quality improvement
• Strong understanding of CMS Star Ratings
• Experience with business intelligence tools such as Power BI Tableau Qlik SQL or similar platforms
• Experience defining business questions and requirements for analytical and technical partners
• Ability to interpret reporting and analytical findings identify root causes and performance drivers and translate insights into practical recommendations
• Proven ability to work across business clinical operational technology analytics and vendor teams
• Experience leading complex initiatives managing accountability resolving issues and influencing outcomes without direct authority
• Excellent communication and presentation skills with the ability to convey complex concepts clearly to senior leadership
  
  

Preferred Qualifications

• Experience with Care Coordination measures including Follow-Up After Emergency Department Visit Transitions of Care and Plan All-Cause Readmissions.

• Experience with payer claims data clinical data supplemental data medical record review or HEDIS audit support.

• Experience working with healthcare vendors and enterprise technology partners.

• Advanced degree in healthcare administration public health business analytics or a related discipline.

Additional Information

To ensure Home or Hybrid Home/Office employees ability to work effectively the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless wired cable or DSL connection is suggested
• Satellite cellular and microwave connection can be used only if approved by leadership
• Employees who live and work from Home in the state of California Illinois Montana or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

As part of our hiring process for this opportunity we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number if it is not already on file. When required an email will be sent from with instructions on how to add the information into your official application on Humanas secure website.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills knowledge experience education certifications etc.

$117600 - $161700 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana Inc. and its affiliated subsidiaries (collectively Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits Humana provides medical dental and vision benefits 401(k) retirement savings plan time off (including paid time off company and personal holidays paid parental and caregiver leave) short-term and long-term disability life insurance and many other opportunities.

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid families individuals military service personnel and communities at large. Learn more about what we offer .

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race color religion sex sexual orientation gender identity national origin age marital status genetic information disability or protected veteran status. It is also the policy of Humana to take affirmative action in compliance with Section 503 of the Rehabilitation Act and VEVRAA to employ and to advance in employment individuals with disability or protected veteran status and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions including but not limited to recruitment hiring upgrading promotion transfer demotion layoff recall termination rates of pay or other forms of compensation and selection for training including apprenticeship at all levels of employment.