Associate Director, HEDIS Operations of Non-Standard Supplemental Business Operations

Associate Director, Hedis Operations Of Non-Standard Supplemental

Become a part of our caring community and help us put health first. The Associate Director of HEDIS Operations of Non-Standard Supplemental for business operations supports all aspects of configuration control, data management, and deficiency reporting. The Associate Director of HEDIS Operations requires a solid understanding of how organization capabilities interrelate across department(s). The Associate Director of HEDIS Non-Standard Supplemental Operations supports all aspects of the non-standard supplemental (NSS) program; including : systems readiness, process improvements, resource deployment, technology implementation, and data management / reporting. The Associate Director of HEDIS Non-Standard Supplemental Operations requires a solid understanding of how organization capabilities interrelate across department(s) throughout the enterprise. This role creates a collaborative environment for their team and partners to determine, and oversee execution of, numerous strategies required to ensure success for our Medicare Stars and Medicaid LOBs. The ideal candidate for this role will thrive in a fast-paced and complex working environment, demonstrates a high level of business and operational acumen, have experience in executing high-priority projects with full accountability, monitor and respond to performance, and cultivate and mature partnerships within the enterprise.

Become an expert in HEDIS & Stars specifications, processes, and schedules. Interpretation of the NCQA technical specifications and regulatory audit requirements to partner on data / process updates; and to provide insights, impacts and guidance to the enterprise. Execution and oversight of seasonal program deliverables; including monitoring both current and upcoming weekly deliverables, ensuring satisfaction of program milestones, and providing transparency into potential risks. Governance of stakeholder deliverables, standards, timelines, milestones, escalations, and issue resolution. Provide leadership and management for the NSS season to ensure optimal outcomes from clinical reviews. Development and maintenance of operational workflows, processes, use of technology and systems. Drive development of new and upcoming systems to complement the operational process and increase productivity. Support clinical quality improvement by championing continuous improvements to operational processes and systems / tools development. Partner to drive and oversee comprehensive program to support quality improvements and holistic data capture. Manage multiple data sets from varying systems to inform resource needs, data value, and report metrics. Interpretation and presentation of data to identify trends and opportunities for improved member health and measure compliance. Internal and external partnerships to coordinate, guide, direct and oversee day-to-day HEDIS activities, including : contingency planning and mitigation, communications, metrics, reporting and prioritization. Identify opportunities across HEDIS processes to ensure compliance and audit requirements are satisfied, while also simultaneously maximizing gap closure. Assist with vendor staffing, strategy, and feedback assessment.

Role Essentials

• Bachelor's Degree or equivalent work experience
• 6+ years of relevant experience in operations and / or project management
• 2 or more years of management / people leader experience
• Demonstrated ability to articulate ideas effectively in both written and oral forms
• Be agile and adaptable to shifting priorities
• Proficient in balancing numerous projects and resource pools simultaneously
• Able to learn and leverage multiple systems and data sets
• Self-starter who assumes accountability for their team's success and strives to maximize results for the enterprise

Role Desirables

Additional Information

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. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home / Office employees with telephone equipment appropriate to meet the business requirements for their position / job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website. Travel : While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours 40

Pay Range $117,600 - $161,700 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and / or individual performance.

Humana, 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline : 12-25-2025

Humana Inc. (NYSE : HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer