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The Medicaid Data Management Lead supports all aspects of configuration control, data management, and deficiency reporting. The Medicaid Data Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Humana's Health Quality and Stars organization is seeking a Medicaid Data Management Lead to lead a dedicated Medicaid team focused on delivering quality and value in a fast-paced, dynamic environment. The successful candidate will be self-directed, highly-engaged, and will demonstrate expertise and business intelligence in supporting execution of the HEDIS program and related activities, all within tightly regulated requirements and timelines. This will require building and maintaining strong relationships with corporate and market teams, including IT, Quality Operations and Compliance, and Risk Adjustment, as well as vended partners.

Additional responsibilities:

Integration of the HEDIS and Medicaid strategies to synchronize operational objectives, vendor technology prioritization and delivery, and satisfaction of regulatory requirements

Provide guidance and recommendations to leadership to drive program efficiencies and performance, as well as implement risk mitigation strategies

Provide proactive direction and insight to enterprise conversations with regulatory and accreditation bodies (CMS, NCQA, AHCA, etc.)

Partner with enterprise stakeholders and external regulatory agencies to influence operational priorities, reporting timelines, and future regulatory landscape

Champion strategic vendor advancements to increase performance efficiencies and position us to absorb Medicaid, membership, and enterprise growth within our HEDIS operations

​ Become an expert in HEDIS and Medicaid specifications, processes, and schedules

Partner to develop comprehensive Medicaid program to support state measure needs, development, and reporting

Drive internal and external partnerships to coordinate, guide, and oversee implementation of clinical measures, as well as all related regulatory activities and reporting

Interpretation and presentation of complicated and large data sets to identify trends, data scenarios, and opportunities for improved member health and measure compliance

Ability to decipher regulatory literature and effectively communicate impacts and changes

Apply critical thinking skills to develop queries, isolate impacts of regulatory changes, and identify patterns in clinical data using Excel, SQL, SAS, etc.

Analyze data to solve a wide variety of business problems and creation of data visualizations that drive strategic vison

Partnership with IT and HEDIS NCQA-certified vendor on tool and reporting enhancements

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

Ensure data quality, timeliness and accuracy

Champion improvements to existing processes

This is a remote position. #LI-remote

Use your skills to make an impact

Required Qualifications

2 years or more of leadership experience

3 years + project management experience

Proficiency in compiling, analyzing, and interpreting data trends and working with large data sets

Superb communication skills (written and verbal) to effectively communicate across teams, levels and functions

Self-starter - comfortable working independently to accomplish components of a larger program

Strong organizational and time management skills

Demonstrated excellence in problem solving/critical thinking with exceptional attention to detail

Ability to manage multiple simultaneous time-sensitive deliverables

Travel - up to 10%

Preferred Qualifications

Bachelor's degree

HEDIS and/or Medicaid Experience

Advanced proficiency in Excel, SQL, SAS, or other data systems

Additional Information

This position may require on-site attendance a minimum of once per month for collaborative meetings if you are local to Louisville. All nationwide candidates are welcome to apply.

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.

Scheduled Weekly Hours

40

Pay Range

The 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.$104,800 - $144,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.