HEDIS Non-Standard Supplemental Operations Solutions Lead

Become a part of our caring community and help us put health first

The HEDIS Non-Standard Supplemental Operations Solutions Lead for business operations supports all aspects of configuration control, data management, and deficiency reporting. This role requires a solid understanding of how the organization’s capabilities interrelate across department(s).

The HEDIS Non-Standard Supplemental (NSS) Product Solutions Lead is responsible for supporting all facets of the HEDIS NSS program and its execution. This role acts as a cross-functional collaborator across various operational swim lanes, driving process improvements and enhancing efficiencies with an emphasis on the adoption and integration of innovative solutions and technologies. This role creates a collaborative environment for their team and partners to determine, and oversee execution of, numerous strategies required to ensure success for Humana’s Medicare Stars and Medicaid Lines of Business.

• Establish and maintain effective professional relationships with key upstream and downstream partners

• Management of program documentation, work groups, and supporting infrastructure

• Coordinate across lanes to understand, advise, and influence future product development and operational expansion

• Develop deeper market relationships to translate market-specific needs into operational processes, controls, and evolution of technological solutions and reporting

• Support exploration, development, and piloting of HEDIS vendor capabilities to enhance operational processes across the two seasons; includes RFP and ongoing vendor evaluation as vendor capabilities advance and expand

• Facilitate initiatives to broaden data collection and enhance manual clinical review processes amidst technological and technical specification changes

• Provide leadership and guidance on continuous improvement efforts with enterprise partners to ensure HEDIS operational needs are accounted for, drive best practice standards, and facilitate communication and sign-off from stakeholders

• Bachelor's degree

• 7 or more years of experience in operations, strategy and/or program management

• 2 or more years of project leadership experience

• Process improvement experience

• Healthcare experience

• Strong analytic experience

• Demonstrated ability to articulate ideas effectively in both written and oral forms

• Master’s degree

• HEDIS and/or CMS Star Ratings experience

• PMP certification

• Lean Six Sigma & Kaizen

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 Hire Vue to enhance our hiring and decision-making ability. Hire Vue 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 Humana’s secure website.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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The compensation…