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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