Note: The job is a remote job and is open to candidates in USA. Humana is a leading U.S. healthcare company that focuses on improving health outcomes and the care experience of its members. They are seeking a Lead, Data Quality/Integrity for Clinical Abstraction Operations to drive excellence in medical record data management and HEDIS data integrity, overseeing vendor relationships and leading cross-functional projects to ensure compliance and quality standards.
Responsibilities
- 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
- 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
- Provide clinical expertise in medical record review to support enterprise-wide initiatives involving medical record data quality, master data management, and supplemental data integration
- 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
- Identify and implement process improvements to enhance efficiency, data quality, and consistency of clinical abstraction workflows
- Develop and review master data management metrics, report on data integrity and quality trends, and recommend strategies for continuous improvement
- Deliver training, guidance, and best practices to both internal teams and external partners regarding clinical abstraction, HEDIS documentation, and data management protocols
- Advise business and technical leaders in developing segment-specific functional strategies for master data management, exercising independent judgment on significant matters
Skills
- 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
- 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
Benefits
- This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
- 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.
- 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.
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