The Senior Quality Improvement Professional leads efforts to improve clinical quality and provider performance for the Humana Healthy Horizons in South Carolina Medicaid Plan. You will develop and implement cross-functional quality improvement initiatives, evaluate business processes and performance outcomes, and drive sustainable, measurable improvements.
Reporting to the Quality Improvement Director, you will collaborate with internal and external stakeholders to advance a provider-focused culture of quality and performance excellence. You will manage complex projects and analyze diverse data sources to identify opportunities, inform strategy, and support organizational objectives.
The Senior Quality Improvement Professional leverages data to lead quality improvement initiatives, monitor performance metrics, and support provider performance enhancement. This role collaborates with provider-facing teams to implement targeted interventions, develop educational resources, and drive achievement of quality and member experience goals. The position leads and participates in multidisciplinary committees, provides strategic clinical guidance on quality initiatives, and influences business decisions through data-driven insights. Operating with a high degree of independence, the Senior Quality Improvement Professional manages complex projects, exercises sound judgment, and recommends solutions to advance organizational objectives.
Essential Role ResponsibilitiesThe Senior Quality Improvement Professional is responsible for improving clinical quality and performance outcomes among South Carolina network providers. Key responsibilities include:
- Partner with Provider Engagement, Network, and Contracting teams to implement clinical quality improvement strategies including education, training and performance reporting.
- Analyze performance data to identify improvement opportunities and develop targeted interventions.
- Lead and participate in cross-functional quality improvement workgroups designed to improve HEDIS, CAHPS, and other performance measures.
- Collaborate with internal and external stakeholders to advance quality and member experience goals.
- Lead provider-focused strategies supporting CAHPS/ECHO and other member experience initiatives.
Use your skills to make an impact Required Qualifications- Bachelor's degree.
- South Carolina residency required.
- 3+ years of healthcare quality improvement experience, including HEDIS, CAHPS, or related performance measures.
- 2+ years of provider-facing experience supporting quality and performance improvement programs.
- Managed care experience, preferably within South Carolina Medicaid.
- Experience analyzing and interpreting healthcare performance data.
- Strong communication, relationship-building, and stakeholder engagement skills.
- Demonstrated ability to work independently, manage multiple priorities, and execute strategic initiatives.
Preferred Qualifications- Advanced Degree.
- Project management experience leading complex or high-impact initiatives.
- Knowledge of South Carolina Medicaid Managed Care requirements.
Workstyle: Remote work at Home with occasional travel for business to Columbia SC
Location: Reside within 2 hours of Columbia SC
Schedule: Monday through Friday 8:30 AM - 5:00 PM Eastern Time
Travel: 5-10%
Work at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
