[Hiring] Lead, Data Quality/Integrity – Clinical Abstraction Operations @Humana

Role Description

Become a part of our caring community. Humana's Stars is an organization that improves health outcomes and improves the care experience of our members and provider partners through quality solutions. The Stars Team is seeking a Lead, Data Quality/Integrity for Clinical Abstraction Vendor Operations. The Lead is responsible for driving excellence in medical record data management and clinical abstraction processes, supporting Humana’s HEDIS initiatives and broader enterprise data integrity goals.

• Lead and manage external vendors responsible for clinical abstraction to close HEDIS gaps.
• Oversee and participate in medical record review and abstraction processes for both hybrid and supplemental HEDIS seasons.
• Provide clinical expertise in medical record review to support enterprise-wide initiatives.
• Conduct clinical member research and analysis as requested by business partners.
• Identify and implement process improvements to enhance efficiency and data quality.
• Develop and review master data management metrics and report on data integrity and quality trends.
• Deliver training, guidance, and best practices to both internal teams and external partners.
• Advise business and technical leaders in developing segment-specific functional strategies.

Qualifications

• Bachelor’s degree in Computer Science, Management Information Systems, Engineering, Math, Business, Nursing, Health Information Management, or a related field.
• 5+ years of technical and/or clinical data management experience.
• Minimum 2 years of project leadership or supervisory experience.
• Experience in Healthcare Operations.
• Experience with data quality management principles and analytics/reporting tools.
• Strong analytical, organizational, and communication skills.
• Demonstrated ability to articulate ideas effectively in both written and oral forms.
• Demonstrated ability to work independently and exercise sound judgment.
• Passion for improving consumer and clinical data experiences.

Requirements

• This role is not eligible for work visa sponsorship.
• Self-provided internet service 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Competitive benefits that support whole-person well-being.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.