HEDIS Non-Standard Supplemental Operations Solutions Lead

📋 Description

• • As the HEDIS Non-Standard Supplemental Operations Solutions Lead at Humana, you will be at the forefront of optimizing critical healthcare quality measurement processes. This pivotal role is designed for an individual passionate about driving operational excellence within the complex landscape of HEDIS (Healthcare Effectiveness Data and Information Set) and Non-Standard Supplemental (NSS) programs. You will be instrumental in shaping and executing strategies that directly impact the quality of care delivered to millions of Humana members across Medicare and Medicaid lines of business.
• • Your primary focus will be on the intricate details of configuration control, data management, and deficiency reporting, ensuring the integrity and accuracy of the data that underpins our quality initiatives. This requires a deep understanding of how various organizational capabilities and systems interconnect, allowing you to identify and implement improvements that span across multiple departments.
• • You will serve as a key cross-functional collaborator, bridging the gap between various operational teams. Your ability to foster a collaborative environment will be crucial in bringing together diverse perspectives to develop and oversee the execution of numerous strategies. These strategies are essential for the success of Humana’s Medicare Stars and Medicaid Lines of Business, directly influencing their performance and member satisfaction.
• • A significant aspect of your role will involve establishing and nurturing strong, effective professional relationships with key upstream and downstream partners. This includes internal teams, external vendors, and other stakeholders, ensuring seamless communication and alignment on program goals and execution.
• • You will be responsible for the meticulous management of program documentation, the facilitation of workgroups, and the oversight of supporting infrastructure. This ensures that all operational aspects of the HEDIS NSS program are well-organized, documented, and supported by robust systems.
• • Your influence will extend to advising and shaping future product development and operational expansion. By coordinating across different operational lanes, you will gain insights into current challenges and opportunities, translating these into actionable recommendations for enhancing our offerings and capabilities.
• • Developing deeper market relationships will be key to your success. You will translate market-specific needs and evolving healthcare trends into refined operational processes, robust controls, and the continuous evolution of technological solutions and reporting mechanisms.
• • A proactive approach to exploring, developing, and piloting new HEDIS vendor capabilities will be essential. You will play a vital role in enhancing operational processes throughout the HEDIS seasons, which includes supporting the Request for Proposal (RFP) process and conducting ongoing vendor evaluations as their capabilities advance and expand.
• • You will facilitate critical initiatives aimed at broadening data collection methods and enhancing manual clinical review processes. This is particularly important as we navigate changes in technological specifications and evolving healthcare data requirements.
• • Providing leadership and guidance on continuous improvement efforts with enterprise partners is a core responsibility. You will ensure that HEDIS operational needs are consistently addressed, drive the adoption of best practice standards across the organization, and facilitate effective communication and formal sign-off from all relevant stakeholders.
• • This role demands a strategic mindset, a keen eye for detail, and the ability to translate complex information into clear, actionable plans. You will be a key driver in ensuring Humana meets its quality commitments, enhances member care, and maintains a competitive edge in the healthcare market.
• • By leveraging your expertise, you will contribute to Humana's mission of putting health first, making a tangible difference in the lives of the people we serve through improved health outcomes and exceptional service delivery.