Senior Quality Improvement Professional

About the role

The Senior Quality Improvement Professional leads efforts to improve clinical quality and provider performance for the Humana Healthy Horizons in South Carolina Medicaid Plan. You will develop and implement cross-functional quality improvement initiatives, evaluate business processes and performance outcomes, and drive sustainable, measurable improvements.

Responsibilities

• Partner with Provider Engagement, Network, and Contracting teams to implement clinical quality improvement strategies including education, training, and performance reporting.
• Analyze performance data to identify improvement opportunities and develop targeted interventions.
• Lead and participate in cross-functional quality improvement workgroups designed to improve HEDIS, CAHPS, and other performance measures.
• Collaborate with internal and external stakeholders to advance quality and member experience goals.
• Lead provider-focused strategies supporting CAHPS/ECHO and other member experience initiatives.

Requirements

• Bachelor's degree.
• South Carolina residency required.
• 3+ years of healthcare quality improvement experience, including HEDIS, CAHPS, or related performance measures.
• 2+ years of provider-facing experience supporting quality and performance improvement programs.
• Managed care experience, preferably within South Carolina Medicaid.
• Experience analyzing and interpreting healthcare performance data.
• Strong communication, relationship-building, and stakeholder engagement skills.
• Demonstrated ability to work independently, manage multiple priorities, and execute strategic initiatives.

Qualifications

• Advanced Degree (preferred).
• Project management experience leading complex or high-impact initiatives.
• Knowledge of South Carolina Medicaid Managed Care requirements.

Skills

Leverages data to lead quality improvement initiatives, monitors performance metrics, and supports provider performance enhancement.

Benefits

Includes medical, dental, and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance, and many other opportunities.

Pay

$78,400 - $107,800 per year.

Schedule

Monday through Friday 8:30 AM - 5:00 PM Eastern Time.

Travel

5-10% travel for business to Columbia SC.