Lead, Data Quality – Clinical Abstraction Operations

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $106.9k - $147k / year

⏰ Full Time

🟠 Senior

📊 Data Scientist

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Lead and manage external vendors responsible for clinical abstraction to close HEDIS (Healthcare Effectiveness Data and Information Set) gaps • Oversee and participate in medical record review and abstraction processes for both hybrid and supplemental HEDIS seasons • Provide clinical expertise in medical record review to support enterprise-wide initiatives involving medical record data quality, master data management, and supplemental data integration • Conduct clinical member research and analysis as requested by business partners • Identify and implement process improvements to enhance efficiency, data quality, and consistency of clinical abstraction workflows • Develop and review master data management metrics, report on data integrity and quality trends, and recommend strategies for continuous improvement • Deliver training, guidance, and best practices to both internal teams and external partners

🎯 Requirements

• 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

🏖️ Benefits

• Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • Short-term and long-term disability • Life insurance