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Humana Quality Improvement Program Lead (National Medicaid Quality) in Boston, Massachusetts


Humana Healthy Horizons is seeking a Quality Improvement Program Lead who will be responsible for the end to end ownership of Humana Healthy Horizon's National Quality Improvement (QI) efforts, capability advancement activities, and the development and maintenance of QI frameworks and toolkits to support Quality associates throughout the line of business. The Quality Improvement Program Lead reports directly to the National Medicaid Quality Director.


The Quality Improvement Program Lead exercises independent judgment and decision making on complex issues within their scope, works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.

Responsibilities include:

  • Provides direction and oversight of Humana's QI programs management model and improvement strategy for the Medicaid line of business at the national level.

  • Develops policy and procedure, and defines/improves processes regarding quality measurement data collection and improvement methodology for all initiatives impacting Medicaid beneficiaries.

  • Develops and maintains QI methodology play books and tool kits to support market QI efforts.

  • Serves as the lead of the Quality related functions related to NCQA's Health Equity Accreditation.

  • Oversees related work plan development and evaluation of programs across all Medicaid markets.

  • Nurtures relationships with national and market partners to expand and strengthen quality improvement efforts.

  • Ensures organizational awareness of key developments and leads in identification and development of national quality interventions.

  • Drives interdepartmental collaboration to achieve business goals.

Required Qualifications

  • Bachelor's degree.

  • 3+ years of experience managing Healthcare Quality programs OR 8+ years of quality improvement experience.

  • 3+ years of experience monitoring and improving quality measures (example HEDIS or CAHPS) in a quality improvement / quality management or office based practice setting.

  • Demonstrated ability to perform moderate to complex data analysis.

  • Strong relationship building skills.

  • Excellent written and oral communication skills.

  • Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel.

  • Ability to work independently under general instructions, must be self-directed and motivated.

  • Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

  • A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

  • Satellite and Wireless Internet service is NOT allowed for this role.

  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

  • 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 .

  • Certified Professional in Healthcare Quality (CPHQ)

  • Experience with quality improvement methodology, preferably with the IHI Model for Improvement. Lean/Six Sigma, or other standardized methodology.

  • Experience with SharePoint design.

  • Advanced degree in business, healthcare, or related field.

  • Project management experience.

  • Strong business acumen.

Additional Information

  • Workstyle: Remote

  • Travel: up to 10%

  • Work Hours: Eastern Standard Time(EST)

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours


Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our