Measure Optimization Lead - Care Coordination

The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings, health condition management, health outcomes, patient experience, and plan operations. In this pivotal role, you will provide HEDIS subject matter expertise and strategic leadership to advance Care Coordination measure performance. You will identify improvement opportunities, guide cross-functional initiatives, and translate approved reporting and analysis into clear recommendations for leadership. Your work will directly support decision-making and Stars improvement efforts that improve member care, strengthen plan quality, and advance organizational goals.

• Lead the HEDIS Care Coordination measure optimization strategy and identify opportunities to improve performance.

• Evaluate business and operational factors affecting measure outcomes and recommend targeted improvements.

• Translate measure requirements, performance insights, and business needs into clear priorities and implementation plans.

• Prepare high-quality materials and recommendations for vice presidents and senior leadership discussions.

• Participate in strategic conversations, providing actionable insights and clear recommendations.

• Communicate complex HEDIS, operational, and performance concepts in a clear and compelling manner to non-technical audiences.

• Collaborate with quality improvement, clinical, operations, technology, analytics, and vendor teams to assess and enhance Care Coordination measure performance.

• Lead initiatives from opportunity identification and business requirements through implementation and continuous improvement.

• Identify and resolve business and operational barriers affecting workflows, supplemental data pathways, source connectivity, and ownership.

• Act as a HEDIS subject matter expert, explaining measure requirements, methodology, and performance implications.

• Partner with analytics teams to frame business questions, interpret approved analyses, and translate findings into practical recommendations.

• Define business reporting requirements and success measures for Care Coordination initiatives.

• Use established dashboards and reporting to communicate key metrics, trends, risks, and improvement opportunities.

• Promote accuracy, consistency, and clarity in business materials and executive communications.

• Bachelor’s degree
• 7 or more years of experience in data analysis and/or business intelligence
• 3 or more years of experience with Medicare Advantage, Stars programs, HEDIS measures, or healthcare quality improvement
• Strong understanding of CMS Star Ratings
• Experience with business intelligence tools such as Power BI, Tableau, Qlik, SQL, or similar platforms
• Experience defining business questions and requirements for analytical and technical partners
• Ability to interpret reporting and analytical findings, identify root causes and performance drivers, and translate insights into practical recommendations
• Proven ability to work across business, clinical, operational, technology, analytics, and vendor teams
• Experience leading complex initiatives, managing accountability, resolving issues, and influencing outcomes without direct authority
• Excellent communication and presentation skills, with the ability to convey complex concepts clearly to senior leadership
  
  

• Experience with Care Coordination measures, including Follow-Up After Emergency Department Visit, Transitions of Care, and Plan All-Cause Readmissions.

• Experience with payer claims data, clinical data, supplemental data, medical record review, or HEDIS audit support.

• Experience working with healthcare vendors and enterprise technology partners.

• Advanced degree in healthcare administration, public health, business, analytics, or a related discipline.

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from with instructions on how to add the information into your official application on Humana’s secure website.

​

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Originally posted on Himalayas