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Humana's Stars is an organization that improves health outcomes and improves the care experience of our members and provider partners through quality solutions. Stars is committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). One key element of this quality rating is the operational execution and performance of the Healthcare Effectiveness Data and Information Set (HEDIS) measures.

The Stars Team is seeking a Lead, Data Quality/Integrity for Clinical Abstraction Vendor Operations. The Lead is responsible for driving excellence in medical record data management and clinical abstraction processes, supporting Humana’s HEDIS initiatives and broader enterprise data integrity goals. This role manages relationships with clinical abstraction vendors, oversees medical record review activities, and serves as a subject matter expert for clinical data initiatives. The Lead will work on complex, cross-functional projects to ensure the highest standards of data quality, integrity, and availability across the organization.

Key Responsibilities

• Vendor Management: Lead and manage external vendors responsible for clinical abstraction to close HEDIS (Healthcare Effectiveness Data and Information Set) gaps, ensuring compliance with contractual obligations, quality standards, and regulatory requirements.
• Medical Record Review: Oversee and participate in medical record review and abstraction processes for both hybrid and supplemental HEDIS seasons, ensuring accuracy, completeness, and timeliness of data collection.
• Clinical Data Expertise: Provide clinical expertise in medical record review to support enterprise-wide initiatives involving medical record data quality, master data management, and supplemental data integration.
• Member Research: Conduct clinical member research and analysis as requested by business partners, using medical records and other data sources to inform strategy, quality improvement, and regulatory reporting.
• Process Improvement: Identify and implement process improvements to enhance efficiency, data quality, and consistency of clinical abstraction workflows.
• Metrics & Reporting: Develop and review master data management metrics, report on data integrity and quality trends, and recommend strategies for continuous improvement.
• Training & Support: Deliver training, guidance, and best practices to both internal teams and external partners regarding clinical abstraction, HEDIS documentation, and data management protocols.
• Stakeholder Collaboration: Advise business and technical leaders in developing segment-specific functional strategies for master data management, exercising independent judgment on significant matters.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in Computer Science, Management Information Systems, Engineering, Math, Business, Nursing, Health Information Management, or a related field.
• 5+ years of technical and/or clinical data management experience, with a demonstrated track record in data quality, integrity, or master data management.
• Minimum 2 years of project leadership or supervisory experience.
• Experience in Healthcare Operations
• Experience with data quality management principles, data architecture, and familiarity with analytics/reporting tools.
• Strong analytical, organizational, and communication skills.
• Demonstrated ability to articulate ideas effectively in both written and oral forms
• Demonstrated ability to work independently, exercise sound judgment, and make decisions in complex, variable environments.
• Passion for improving consumer and clinical data experiences.

Preferred Qualifications

• Master’s degree in a relevant discipline.
• Clinical licensure or credential.
• Deep understanding of HEDIS abstraction, medical record review processes, and related regulatory/compliance requirements.
• Experience managing clinical abstraction vendors or large-scale medical record review projects.
• Experience with supplemental data submission for HEDIS or value-based care programs.

Additional Information

This role is not eligible for work visa sponsorship.

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