Senior Quality Improvement Professional
Core
Lead provider-focused, cross-functional initiatives to improve clinical quality, provider performance, and member experience for the Humana Healthy Horizons in South Carolina Medicaid Plan.
Role type
Senior Quality Improvement Professional (Healthcare)
Builds
Provider performance strategies, quality improvement workgroups, and member experience initiatives
Domain
Healthcare / Medicaid Managed Care
Required skills
Healthcare quality improvement, HEDIS/CAHPS performance measures, provider engagement, data analysis, project management, strategic planning
Preferred skills
Advanced degree, CPHQ certification, structured quality improvement methodologies (PDSA), knowledge of South Carolina Medicaid requirements
Technologies
Excel, reporting tools, visualization tools
Responsibilities
Partner with Provider Engagement and Network teams to implement clinical quality improvement strategies; Analyze provider-level performance data to identify care gaps and prioritize interventions; Lead cross-functional workgroups to improve HEDIS, CAHPS, and other performance measures; Collaborate with stakeholders to advance quality and strengthen member outreach; Lead provider-focused strategies supporting CAHPS/ECHO and member experience initiatives; Maintain documentation of improvement plans, interventions, outcomes, and corrective actions.
Seniority
Senior, hands-on IC
