Senior Quality Improvement Professional

Become a part of our caring community The Senior Quality Improvement Professional leads efforts to improve clinical quality and provider performance for the Humana Healthy Horizons in South Carolina Medicaid Plan. You will develop and implement cross-functional quality improvement initiatives, evaluate business processes and performance outcomes, and drive sustainable, measurable improvements.

Become a part of our caring community The Senior Quality Improvement Professional leads efforts to improve clinical quality and provider performance for the Humana Healthy Horizons in South Carolina Medicaid Plan. You will develop and implement cross-functional quality improvement initiatives, evaluate business processes and performance outcomes, and drive sustainable, measurable improvements. Reporting to the Quality Improvement Director, you will collaborate with internal and external stakeholders to advance a provider-focused culture of quality and performance excellence.

You will manage complex projects and analyze diverse data sources to identify opportunities, inform strategy, and support organizational objectives. The Senior Quality Improvement Professional leverages data to lead quality improvement initiatives, monitor performance metrics, and support provider performance enhancement. This role collaborates with provider-facing teams to implement targeted interventions, develop educational resources, and drive achievement of quality and member experience goals.

The position leads and participates in multidisciplinary committees, provides strategic clinical guidance on quality initiatives, and influences business decisions through data-driven insights. Operating with a high degree of independence, the Senior Quality Improvement Professional manages complex projects, exercises sound judgment, and recommends solutions to advance organizational objectives.

• Partner with Provider Engagement, Network, and Contracting teams to implement clinical quality improvement strategies including education, training and performance reporting.
• Analyze performance data to identify improvement opportunities and develop targeted interventions.
• Lead and participate in cross-functional quality improvement work groups designed to improve HEDIS, CAHPS, and other performance measures.
• Collaborate with internal and external stakeholders to advance quality and member experience goals.
• Lead provider-focused strategies supporting CAHPS/ECHO and other member experience initiatives.

Use your skills to make an impact

• Bachelor's degree.
• South Carolina residency required.
• 3+ years of healthcare quality improvement experience, including HEDIS, CAHPS, or related performance measures.
• 2+ years of provider-facing experience supporting quality and performance improvement programs.
• Managed care experience, preferably within South Carolina Medicaid.
• Experience analyzing and interpreting healthcare performance data.
• Strong communication, relationship-building, and stakeholder engagement skills.
• Demonstrated ability to work independently, manage multiple priorities, and execute strategic initiatives.

• Advanced Degree.
• Project management experience leading complex or high-impact initiatives.
• Knowledge of South Carolina Medicaid Managed Care requirements.

Remote work at Home with occasional travel for business to Columbia SC

Reside within 2 hours of Columbia SC

Monday through Friday 8:30 AM - 5:00 PM Eastern Time

5-10%

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…