Lead, Data Quality/Integrity - Clinical Abstraction Operations

Become a part of our caring community Humana's Stars is an organization that improves health outcomes and 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 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. 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. Scheduled Weekly Hours 40 Pay Range $106,900 – $147,000 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole‑person well‑being. Associate benefits include medical, dental and vision coverage, a 401(k) retirement savings plan, paid time off, paid parental and caregiver leave, short‑term and long‑term disability, life insurance and more. Equal Opportunity Employer 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. #J-18808-Ljbffr Humana Inc