Become a part of our caring community and help us put health first
We are seeking a Senior Quality Measurement Professional with expertise in clinical quality measurement to join a team focused on driving better outcomes and more cost-effective care for our 5 million Medicare members…
Location: remote
The Senior Quality Measurement Professional will support the identification, development, and implementation of quality measures that will drive better health outcomes and more cost-effective care for our members. The process of optimizing healthcare starts with measuring the results of current processes and care patterns. This role will focus on identifying and developing high-value, high-impact, evidence-based quality measures that will address both low-value care and high-value care opportunities. This individual will collaborate with a multidisciplinary team of clinicians, methodologists, and analysts to ensure measures prioritized are data-driven, clinically-sound, and patient centered; ultimately supporting enterprise quality and cost of care strategies.
Key Responsibilities
• Support collaboration with cross-functional partners (e.g., clinicians, analysts/data scientist, clinical SMEs/leaders) to identify, prioritize, and build evidence-based quality measures.
• Work directly with analytic partners to evaluate clinical areas and develop measure concepts: leverage data, analytics, and insights to identify the greatest opportunities for clinical quality measurement (e.g., high spend/utilization clinical areas, etc.).
• Review and compile quality measures currently from national programs and medical specialty societies to inform measure prioritization.
• Complete comprehensive literature reviews to support development of new quality measures.
• Develop precise technical specifications for prioritized measures, identifying data sources and applicable code sets. Work directly with analytic partners to construct analytic protocols and other measure specification documents.
• Work directly with key enterprise partners to implement quality measures to support quality and value initiatives with multiple enterprise partners.
• Partner with analytic and operational partners to evaluate and validate effectiveness of implemented initiatives.
Role Essentials
Use your skills to make an impact
• Registered Nurse or Pharmacist
• 5+ years of clinical experience
• Experience working with clinical quality measures, quality improvement strategies, policy and/or clinical informatics
• Strong familiarity with the healthcare industry
• Excellent written and verbal communication skills, with ability to present complex information to senior-level audiences
• Proven ability to work collaboratively across teams and stakeholders
• Engage in ambiguous problem solving
• High learning acuity and ability to navigate rapidly changing situations and business priorities
Role Desirables
• Demonstrated experience working with healthcare claims data sets, including medical coding and medical claims.
• Experience in medical cost opportunity and gaps in care identification.
• Experience working with multi-disciplinary teams (e.g., data scientists/analysts, actuaries, clinicians, operational leaders, etc.), with evidence of deep understanding of healthcare data and health-systems operations.
• Expertise in critically reviewing & synthesizing recommendations and insights from clinical society guidelines & literature.
• Clinical Informatics degree
• Medical billing & coding degree and/or certification
Additional Information
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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 [email protected] with instructions on how to add the information into your official application on Humana’s secure website.
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.
$84,600 – $116,300 per year
This 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 veteran status. 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
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