Senior HEDIS Data Manager

Humana Inc.

Job Overview

Location

Remote Nationwide

Job Type

Full-time

Full Job Description

📋 Description

• Serve as the primary owner of HEDIS, Medicare Stars, and Medicaid data programs, ensuring accurate, timely, and compliant regulatory reporting across all markets.
• Interpret complex regulatory specifications from NCQA and CMS to guide internal teams and external vendors on data collection, measurement, and submission requirements.
• Lead collaboration with IT, Quality Operations, Compliance, and third-party HEDIS NCQA-certified vendors to enhance data systems, reporting tools, and technical configurations.
• Analyze large-scale clinical and administrative data sets to identify trends, gaps in care, and opportunities for improving measure performance and member health outcomes.
• Develop and maintain data visualizations and dashboards using tools such as Power BI to communicate strategic insights to leadership and cross-functional stakeholders.
• Design, implement, and track key performance metrics for HEDIS, Stars, and Medicaid programs, ensuring alignment with organizational goals and regulatory timelines.
• Oversee vendor performance and contractual obligations related to HEDIS data extraction, validation, and reporting, ensuring adherence to quality and timeliness standards.
• Champion process improvements to increase data accuracy, reduce manual effort, and streamline end-to-end HEDIS operations across the enterprise.
• Execute advanced data queries and analyses using SQL, Excel, and other analytical tools to isolate impacts of regulatory changes and resolve data anomalies.
• Maintain strict confidentiality and compliance with HIPAA and PHI protections by working from a dedicated, interruption-free workspace.
• Prepare and present comprehensive reports on HEDIS performance, data quality, and regulatory readiness to executive leadership and internal partners.
• Build and sustain strong professional relationships with upstream (clinical, IT) and downstream (compliance, reporting) teams to ensure seamless data flow and operational alignment.
• Adapt quickly to evolving regulatory landscapes, shifting priorities, and dynamic business needs while maintaining high standards of precision and accountability.
• Ensure all data deliverables are thoroughly reviewed for accuracy, completeness, and timeliness prior to regulatory submission deadlines.

🎯 Requirements

• Bachelor’s degree
• 5 or more years of technical experience
• Demonstrated ability to proactively initiate and drive projects with minimal supervision
• Strong analytical skills with ability to evaluate complex issues and develop innovative solutions
• Proven experience managing multiple priorities under tight deadlines in a fast-paced environment
• Proficiency in SQL, Excel, and experience with data extraction and analysis tools such as CQL, Power BI, or PowerShell

🏖️ Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Paid time off, company holidays, volunteer time off, and paid parental and caregiver leave
• Short-term and long-term disability coverage
• Life insurance
• Bonus incentive plan based on company and/or individual performance
• Bi-weekly internet expense stipend for employees in California, Illinois, Montana, or South Dakota
• Provision of telephone equipment for remote work

Skills & Technologies

Senior

Remote

$97k-133k

Degree Required

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Humana Inc.

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About Humana Inc.

Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.

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