Principal Quality Measurement

Profile

Description

Humana has articulated a long-term vision to transform from a health insurance company to a health services company distinguished by the prioritization of the health outcomes of our members. By focusing on the health measures that matter most to consumers, our health outcomes strategy will help catalyze this transformation. This role will be instrumental in developing and executing on this vision in partnership with leaders across Humana.

Responsibilities

As the Principal, Quality Measurement, you will lead projects that focus on quality measures that help a variety of stakeholders to measure healthcare outcomes, patient experience and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.

Provide leadership and oversight of the research of quality/outcome measure development and implementation, including developing the technical and research plans for measure development, identifying data sources and applicable codes, defining measure specifications, developing risk adjustment models, designing validity and reliability testing, developing matching methods to compare populations, visualizing & communicating results to senior leaders, associates, and external audiences, identifying technical roadblocks and solutions relating to implementing measures, and conceptualizing and supervising research to understand drivers of quality/outcome measures

Influence senior decision-makers at Humana on opportunities to improve clinical quality in order to drive health outcomes, lower costs, and improve experience for members and providers. Work closely with senior leaders to solicit input, guide data-backed problem solving, and make recommendations to advance the clinical quality strategy. Communicate strategic insights to leaders at all levels, including management team.

Serve as an enterprise quality subject matter expert, consult to business teams, and represent the quality measurement team to internal stakeholders.

Engage internal stakeholders and external experts to identify priority areas for measure selection and development, leading the development of measure concepts and theory of actions, providing analysis of merits and technical aspects of developing such measures, and developing business case for new measures.

Serve as data/analytical liaison between Clinical Transformation team and data analysts/scientists around quality measure development and implementation. Support and supervise technical project leads by providing technical guidance, meeting regularly, reviewing outputs, providing input on progress, and responding to questions related to assigned tasks. Translate business needs to analytical plan/steps, and translate analytical findings to business insights

Collaborate with external stakeholders including quality experts to obtain feedback about measures, obtain validation, develop relationships to test measures, and drive adoption

Represent the quality measurement team to provide expert opinions to external stakeholders on quality measures and communicate Humana's work via publications and presentations

Strategically problem-solve the methodological/team/process issues that arise with teams, directors, and analysts related to assigned work.

Exercise independent judgment and decision making on complex issues, advise senior leaders on matters of significance relating to quality, and work under minimal supervision.

Required Qualifications

Master's degree/Ph.D. preferred in quantitative discipline in health care research field, such as Biostatistics, Health Economics, or Epidemiology

Advanced subject matter expertise and minimum 5 years of experience leading the development of healthcare quality measures including developing the technical and research plans for measure development. This includes understanding measure gaps and performing landscape review of existing measures, evaluating potential measure concepts, developing a business case, identifying data sources, defining measure specifications, obtaining clinical validation, developing risk adjustment models, designing validity & reliability testing, developing matching methods to compare populations, and visualizing & communicating performance.

Comprehensive knowledge about federal government healthcare quality measures and applications, measure evaluation criteria, and measure endorsement process

Demonstrated experience working with payer data including medical coding and medical claims

Minimum 10 years working in technical components of health services, health policy, or related research

Minimum 3 years of experience with technical program management including leading a data scientist team (e.g., setting and driving the agenda, ensuring timelines are met, and validating quality).

Strong communication skills both verbal and written and proven presentation skills (comfortable presenting to all levels of the organization)

Demonstrated competencies in epidemiology, health policy and analytical skills.

Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs. Excellent project management skills and experience leading the execution of large scale initiatives. Demonstrated experience managing multiple tasks simultaneously that cover a broad range of technical areas and adhering to deadlines.

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field

Preferred Qualifications

Clinical degree such as medical or nursing degree

Clinical informatics degree

Experience with Value-Based Purchasing models

Medical coding degree

Knowledge about health insurance plan networks, clinical and business analytics and policy levers

Additional Information

This position is remote (central and eastern time zones preferred) and will require occasional travel (approximately 10%) to Humana headquarters in Louisville, KY and other Humana locations.

Additional Information

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com