[Remote] Associate Director, HEDIS Operations of Non-Standard Supplemental – Business Operations at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Bachelor's Degree or equivalent work experience
6+ years of relevant experience in operations and/or project management
2 or more years of management/people leader experience
Demonstrated ability to articulate ideas effectively in both written and oral forms
Be agile and adaptable to shifting priorities
Proficient in balancing numerous projects and resource pools simultaneously
Able to learn and leverage multiple systems and data sets
Self-starter who assumes accountability for their team’s success and strives to maximize results for the enterprise

Responsibilities

Supports all aspects of configuration control, data management, and deficiency reporting
Supports all aspects of the non-standard supplemental (NSS) program, including systems readiness, process improvements, resource deployment, technology implementation, and data management/reporting
Creates a collaborative environment for team and partners to determine and oversee execution of strategies for Medicare Stars and Medicaid LOBs success
Become an expert in HEDIS & Stars specifications, processes, and schedules
Interpretation of the NCQA technical specifications and regulatory audit requirements to partner on data/process updates and provide insights, impacts, and guidance to the enterprise
Execution and oversight of seasonal program deliverables, including monitoring weekly deliverables, ensuring program milestones, and providing transparency into potential risks
Governance of stakeholder deliverables, standards, timelines, milestones, escalations, and issue resolution
Provide leadership and management for the NSS season to ensure optimal outcomes from clinical reviews
Development and maintenance of operational workflows, processes, use of technology and systems
Drive development of new and upcoming systems to complement operational processes and increase productivity
Support clinical quality improvement by championing continuous improvements to operational processes and systems/tools development
Partner to drive and oversee comprehensive program to support quality improvements and holistic data capture
Manage multiple data sets from varying systems to inform resource needs, data value, and report metrics
Interpretation and presentation of data to identify trends and opportunities for improved member health and measure compliance
Internal and external partnerships to coordinate, guide, direct and oversee day-to-day HEDIS activities, including contingency planning and mitigation, communications, metrics, reporting, and prioritization
Identify opportunities across HEDIS processes to ensure compliance and audit requirements are satisfied while maximizing gap closure
Assist with vendor staffing, strategy, and feedback assessment

Skills

Key technologies and capabilities for this role

HEDISNCQAMedicare StarsMedicaidData ManagementProcess ImprovementRegulatory ComplianceStakeholder ManagementProject ExecutionRisk ManagementGovernanceOperationsBusiness Acumen

Questions & Answers

Common questions about this position

What is the employment type for this role?

This is a full-time position.

What are the key responsibilities of this position?

The role involves supporting configuration control, data management, deficiency reporting, systems readiness, process improvements, resource deployment, technology implementation, and overseeing strategies for Medicare Stars and Medicaid LOBs.

What skills or experience does the ideal candidate need?

The ideal candidate thrives in a fast-paced and complex environment, demonstrates high business and operational acumen, has experience executing high-priority projects with full accountability, and expertise in HEDIS & Stars specifications, processes, and schedules.

What is the company culture like for this role?

The role emphasizes creating a collaborative environment for the team and partners, cultivating partnerships within the enterprise, and working in a caring community focused on putting health first.

What makes a strong candidate for this Associate Director position?

Strong candidates will have a solid understanding of organization capabilities across departments, experience in HEDIS operations, ability to interpret NCQA specifications, lead high-priority projects, and drive process improvements and partnerships.

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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