Director, HEDIS Standards and Strategic Enablement

Humana Inc. is committed to putting health first and is seeking a Director of HEDIS Standards and Strategic Enablement to lead a team focused on delivering HEDIS results and implementing strategic solutions. The role involves overseeing compliance, risk management, and quality audits while fostering relationships across corporate and market teams.

Responsibilities:

• Provide HEDIS technical specification expertise and consultation – ensuring operations are appropriately governed by specifications and strategic levers are in-play to optimize measure performance
• Lead HEDIS clinical and data integrity audit readiness strategies and continuous monitoring programs to mitigate compliance and regulatory risk
• Lead HEDIS clinical curriculum development and delivery to support medical record review and data file integrity activities
• Own HEDIS standards for measure interpretation, documentation requirements, and compliance guidance
• Own risk management planning related to regulatory submissions, including identification of vulnerabilities and development of mitigation strategies
• Provide senior-level communication and recommendations on compliance risks, quality performance, and improvement opportunities
• Serve as enablement liaison and collaborator across cross-functional teams and operational swim lanes to ensure alignment of quality initiatives and performance goals
• Lead clinical process strategic framework development to support consistent and high-quality HEDIS data collection and submission
• Advise and influence team strategy, supporting initiatives, and long-term roadmap; including supporting strategic exploration efforts by shaping pilots, defining success criteria, and guiding execution paths
• Lead large-scale, high-impact strategic initiatives to optimize operational efficiencies and performance outcomes
• Accelerate shared accountability for continuous improvement by ensuring partner transparency, creating alignment, inspiring action, and delivering tangible results
• Foster a culture of quality, accountability, and continuous improvement across quality functions

Requirements:

• Bachelor's Degree
• 8 years of experience in healthcare, clinical operations, portfolio coordination and/or consulting
• HEDIS experience and expertise
• Expertise in program administration, planning frameworks and performance tracking
• Experience leading teams, growing talent and leading cross-functionally
• Demonstrated success executing strategic initiatives from planning through delivery, ensuring measurable outcomes
• Experience leading complex cross-functional execution in matrixed environments
• High organizational agility and innovative thinking
• Experience and comfort operating at both strategic and tactical levels
• Strong decision-making skills, particularly with high impact on efficiency, effectiveness, completeness, and accuracy
• Confidence and comfort in conversing with senior management, business leaders and external parties
• Exposure to Automated Intelligence (AI) implementations and solutions