HEDIS Senior Data Manager

Profile

Description

Humana's Health Quality and Stars organization is seeking a HEDIS Senior Data Manager to deliver 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.

Responsibilities

Responsibilities

The HEDIS Senior Data Manager is accountable for engaging in and supporting all aspects of the HEDIS program and regulatory operations, including: vendor oversight, process development, system and technical configurations, and management of efforts to maximize HEDIS results. The HEDIS Senior Data Manager champions a collaborative environment where the team and connected partners align on appropriate strategies for each successful season, ensuring all regulatory submissions of data collection and reporting are accurate, complete and timely. This position requires demonstration of a high level of business acumen as well as cultivating and maturing partnerships within the enterprise. Through individual and team contributions, the HEDIS Senior Data Manager is responsible for the following:

Become an expert in HEDIS & Stars specifications, processes, and schedules

Support clinical quality improvement by developing code, creating reports, and improving data/analytic capabilities for the broader Health Quality and Stars organization

Data collection and manipulation from numerous sources (Oracle, SQL, Excel, etc.) with an understanding of database structure design

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

Internal and external partnerships to coordinate, guide, direct and oversee day-to-day HEDIS activities, including: contingency planning and mitigation, communications, metrics, reporting and prioritization

Development, tracking and presentation of season metrics and reporting

Identify opportunities across HEDIS processes to ensure compliance and audit requirements are satisfied, while also simultaneously maximizing gap closure

Interpretation of the NCQA technical specifications and regulatory audit requirements to partner on data/process updates; and to provide insights, impacts and guidance to the enterprise

Professional Maturity

Passion for contributing to a cross-functional team focused on continuously improving member experiences and clinical outcomes though data analysis and interpretation

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

Operational Execution

Ensure data quality, timeliness and accuracy

Leverage existing talent and expertise within department to drive efficiency and effectiveness

Champion improvements to existing processes

Required Qualifications

Bachelor's Degree or equivalent experience

3 years experience in healthcare, insurance or related industry

3 years of technical experience in data reporting

Advanced proficiency in SQL, SAS, Python and other data systems

Successful experience managing complex projects beginning-to-end

Proficiency in compiling, analyzing, and interpreting data trends

Strong consultative and collaborative skills working with a variety of teams and internal/external partners

Strong analytical skills and experience with large, complicated datasets

Self-motivated, proactive, highly organized, and demonstrated critical thinking skills

Excellent communication skills (written and verbal)

Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint and Visio

Preferred Qualifications

Stars or HEDIS Experience

Process proficiency with ability to develop new end-to-end processes and effectively optimize existing work processes to predict, address and resolve efficiency and accuracy constraints

Background in metrics/KPI development and management

Additional Information

This position can be a Hybrid Position located in the Humana Tower Louisville or via remote work

Scheduled Weekly Hours

40

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.

Company info

Humana Inc.
Website : http://www.humana.com