About Humana


Job Category:

Member Quality & Financials - Risk Adjustment & STARS operations


United States

Approximate Salary:

Not Specified

Position Type:

Full Time

Senior Program Delivery Professional - HEDIS

Humana - Work At Home, Kentucky

Posted: 12/10/2018


The Senior Program Delivery Professional strategically identifies, develops, and implements programs that influence providers, members or market leadership towards value-based relationships and/or improved quality metrics. The Senior Program Delivery Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.


Manages HEDIS projects and initiatives according to direction provided by our government contract(s).  Analyzes data for specific HEDIS® measures to compare Humana Government Business performance with commercial health plans reporting HEDIS® measures. Evaluate select HEDIS® measures to assess barriers, gaps and opportunities for improvement. Works with senior leaders in development of a comprehensive plan for increasing success in achieving the select HEDIS® measures. Manage all components of the project life cycle: initiation, planning, execution, monitoring, metrics, outcomes measurement, reporting and closing.  Works collaboratively and professionally with internal and external customers.  Maintains current knowledge of HEDIS requirements and criteria.

  • Conduct comprehensive analysis of HEDIS® data to assess barriers, gaps and opportunities for improvement
  • Utilize trend analysis, performance thresholds, and national and regional benchmarks to analyze HEDIS® data
  • Work closely with the CQM Department and HEDIS team to identify potential health improvement initiatives and strategies to meet target goals and contract requirements
  • Develop, manage, monitor, report and update HEDIS® projects
  • Collaborate with internal and external customers to maximize opportunities to influence government requirements, coordinate efforts with other departments, and utilize best practices in meeting or exceeding contract expectations. 


Required Qualifications

  • Our Department of Defense contract requires U.S. Citizenship
  • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
  • Bachelor’s degree statistics, mathematics, economics, business, accounting or related analytic discipline
  • Minimum three years managed care experience in analyzing HEDIS® data
  • Prior experience working in system analytics and/or data warehousing environment
  • Strong verbal and written communication skills
  • Strong data analysis skills
  • Advanced computer literacy
  • Capable and successful negotiator

Preferred Qualifications

  • Prior Supervisory experience
  • Project Management certification (PMP, CAPM)
  • Master’s degree in statistics, mathematics, economics, or related analytic discipline

Scheduled Weekly Hours


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