HEDIS Non-Standard Supplemental Operations Solutions Lead

Become a part of our caring community and help us put health first
 The HEDIS Non-Standard Supplemental Operations Solutions Lead for business operations supports all aspects of configuration control, data management, and deficiency reporting. This role requires a solid understanding of how the organization’s capabilities interrelate across department(s).

The HEDIS Non-Standard Supplemental (NSS) Product Solutions Lead is responsible for supporting all facets of the HEDIS NSS program and its execution. This role acts as a cross-functional collaborator across various operational swim lanes, driving process improvements and enhancing efficiencies with an emphasis on the adoption and integration of innovative solutions and technologies. This role creates a collaborative environment for their team and partners to determine, and oversee execution of, numerous strategies required to ensure success for Humana’s Medicare Stars and Medicaid Lines of Business.

Responsibilities include:

• Establish and maintain effective professional relationships with key upstream and downstream partners

• Management of program documentation, workgroups, and supporting infrastructure

• Coordinate across lanes to understand, advise, and influence future product development and operational expansion

• Develop deeper market relationships to translate market-specific needs into operational processes, controls, and evolution of technological solutions and reporting

• Support exploration, development, and piloting of HEDIS vendor capabilities to enhance operational processes across the two seasons; includes RFP and ongoing vendor evaluation as vendor capabilities advance and expand

• Facilitate initiatives to broaden data collection and enhance manual clinical review processes amidst technological and technical specification changes

• Provide leadership and guidance on continuous improvement efforts with enterprise partners to ensure HEDIS operational needs are accounted for, drive best practice standards, and facilitate communication and sign-off from stakeholders

Use your skills to make an impact
 

Role Essentials

• Bachelor's degree

• 7 or more years of experience in operations, strategy and/or program management

• 2 or more years of project leadership experience

• Process improvement experience

• Healthcare experience

• Strong analytic experience

• Demonstrated ability to articulate ideas effectively in both written and oral forms

Role Desirables

• Master’s degree

• HEDIS and/or CMS Star Ratings experience

• PMP certification

• Lean Six Sigma & Kaizen

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. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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 [email protected] 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

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$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.

Description of Benefits

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: 03-05-2026
About us
 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.

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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.