Director, HEDIS Standards and Strategic Enablement

📋 Description

• • As the Director of HEDIS Standards and Strategic Enablement at Humana, you will be at the forefront of ensuring the quality and integrity of our Healthcare Effectiveness Data and Information Set (HEDIS) measures, a critical component of our commitment to delivering exceptional care and achieving high ratings from the Centers for Medicare and Medicaid Services (CMS).
• • This pivotal role within the Health Quality and Stars (HQS) organization involves leading a dedicated team of professionals responsible for the meticulous execution of HEDIS results within stringent regulatory frameworks and tight timelines.
• • You will be instrumental in developing and implementing key strategic solutions designed to advance HQS operations and enhance overall performance, directly impacting the health outcomes and care experiences of our members and provider partners.
• • As a leader of a shared services function, your responsibilities will encompass overseeing and guiding critical areas such as HEDIS quality enablement, HEDIS clinical education and delivery, robust regulatory compliance, proactive risk management and mitigation, and comprehensive quality audits and readiness programs.
• • This position demands a strategic mindset, with a focus on defining and building frameworks that propel operational advancements and yield superior outcomes. You will champion initiatives that align with Humana's vision and strategic objectives, ensuring that our quality programs are not only compliant but also innovative and effective.
• • Success in this role hinges on your ability to cultivate and nurture strong, collaborative relationships with corporate and market teams, demonstrating a self-directed and highly engaged approach to your work.
• • Operating with the utmost integrity and authenticity will be paramount, as you navigate complex challenges and drive meaningful change within the organization.
• • You will serve as the primary expert for HEDIS technical specifications, providing in-depth consultation to ensure operations are governed by these critical standards and that strategic levers are effectively employed to optimize measure performance.
• • A key responsibility includes leading the development and execution of HEDIS clinical and data integrity audit readiness strategies, alongside implementing continuous monitoring programs designed to proactively mitigate compliance and regulatory risks.
• • You will also lead the creation and delivery of comprehensive HEDIS clinical curricula, essential for supporting medical record review and ensuring the integrity of data file activities.
• • Owning HEDIS standards for measure interpretation, documentation requirements, and compliance guidance will be central to your role, ensuring consistency and accuracy across all HEDIS-related processes.
• • Furthermore, you will be responsible for owning risk management planning specifically related to regulatory submissions, which includes identifying potential vulnerabilities and developing robust mitigation strategies to safeguard compliance.
• • Providing senior-level communication and strategic recommendations on compliance risks, quality performance trends, and actionable improvement opportunities to leadership will be a core function.
• • You will act as a crucial enablement liaison and collaborator, working seamlessly across diverse cross-functional teams and operational swim lanes to guarantee the alignment of quality initiatives with overarching performance goals.
• • Leading the development of a strategic framework for clinical processes will be essential to support consistent, high-quality HEDIS data collection and submission practices.
• • Your role will involve advising and influencing team strategy, championing key initiatives, and shaping the long-term roadmap for HQS, including supporting strategic exploration efforts through the definition of pilot programs, success criteria, and execution guidance.
• • You will lead large-scale, high-impact strategic initiatives aimed at optimizing operational efficiencies and enhancing performance outcomes across the HEDIS landscape.
• • Fostering shared accountability for continuous improvement will be achieved by ensuring partner transparency, creating strong alignment, inspiring proactive action, and consistently delivering tangible, measurable results.
• • Ultimately, you will cultivate a pervasive culture of quality, accountability, and continuous improvement throughout all quality functions within Humana, reinforcing our commitment to putting health first.