Lead, Data Quality/Integrity - Clinical Abstraction Operations

Beschreibung:

Become a part of our caring community

Humana's Stars is an organization that improves health outcomes and improves the care experience of our members and provider partners through quality solutions. Stars 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.

The Stars Team is seeking a Lead, Data Quality/Integrity for Clinical Abstraction Vendor Operations. The Lead is responsible for driving excellence in medical record data management and clinical abstraction processes, supporting Humana's HEDIS initiatives and broader enterprise data integrity goals. This role manages relationships with clinical abstraction vendors, oversees medical record review activities, and serves as a subject matter expert for clinical data initiatives. The Lead will work on complex, cross-functional projects to ensure the highest standards of data quality, integrity, and availability across the organization.

Key Responsibilities
* Vendor Management: Lead and manage external vendors responsible for clinical abstraction to close HEDIS (Healthcare Effectiveness Data and Information Set) gaps, ensuring compliance with contractual obligations, quality standards, and regulatory requirements.
* Medical Record Review: Oversee and participate in medical record review and abstraction processes for both hybrid and supplemental HEDIS seasons, ensuring accuracy, completeness, and timeliness of data collection.
* Clinical Data Expertise: Provide clinical expertise in medical record review to support enterprise-wide initiatives involving medical record data quality, master data management, and supplemental data integration.
* Member Research: Conduct clinical member research and analysis as requested by business partners, using medical records and other data sources to inform strategy, quality improvement, and regulatory reporting.
* Process Improvement: Identify and implement process improvements to enhance efficiency, data quality, and consistency of clinical abstraction workflows.
* Metrics & Reporting: Develop and review master data management metrics, report on data integrity and quality trends, and recommend strategies for continuous improvement.
* Training & Support: Deliver training, guidance, and best practices to both internal teams and external partners regarding clinical abstraction, HEDIS documentation, and data management protocols.
* Stakeholder Collaboration: Advise business and technical leaders in developing segment-specific functional strategies for master data management, exercising independent judgment on significant matters.

Use your skills to make an impact

Required Qualifications
* Bachelor's degree in Computer Science, Management Information Systems, Engineering, Math, Business, Nursing, Health Information Management, or a related field.
* 5+ years of technical and/or clinical data management experience, with a demonstrated track record in data quality, integrity, or master data management.
* Minimum 2 years of project leadership or supervisory experience.
* Experience in Healthcare Operations
* Experience with data quality management principles, data architecture, and familiarity with analytics/reporting tools.
* Strong analytical, organizational, and communication skills.
* Demonstrated ability to articulate ideas effectively in both written and oral forms
* Demonstrated ability to work independently, exercise sound judgment, and make decisions in complex, variable environments.
* Passion for improving consumer and clinical data experiences.

Preferred Qualifications
* Master's degree in a relevant discipline.
* Clinical licensure or credential.
* Deep understanding of HEDIS abstraction, medical record review processes, and related regulatory/compliance requirements.
* Experience managing clinical abstraction vendors or large-scale medical record review projects.
* Experience with supplemental data submission for HEDIS or value-based care programs.

Additional Information

This role is not eligible for work visa sponsorship.

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 required; 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 Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.

Work at Home Requirements 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours
40

Pay RangeThe 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.

$106,900 - $147,000 per year

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

Description of BenefitsHumana, 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.

Application Deadline: 07-02-2026

About us

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 at Humana.com and at CenterWell.com.

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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