Senior Quality Improvement Professional

About the role

Become a part of our caring community

The Senior Quality Improvement Professional leads provider-focused, cross-functional initiatives to improve clinical quality, provider performance, and member experience 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.

Reporting to the Quality Improvement Director, you will collaborate with internal and external stakeholders to advance a provider-focused culture of quality and performance excellence. You will manage complex projects and analyze diverse data sources to identify opportunities, inform strategy, and support organizational objectives.

The Senior Quality Improvement Professional leverages data to lead quality improvement initiatives, monitor performance metrics, and support provider performance enhancement. This role collaborates with provider-facing teams to implement targeted interventions, develop educational resources, and drive achievement of quality and member experience goals.

The position leads and participates in multidisciplinary committees, provides strategic clinical guidance on quality initiatives, and influences business decisions through data-driven insights. Operating with a high degree of independence, the Senior Quality Improvement Professional manages complex projects, exercises sound judgment, and recommends solutions to advance organizational objectives.

Essential Role Responsibilities

The Senior Quality Improvement Professional is responsible for improving clinical quality and performance outcomes among South Carolina network providers. Key responsibilities include:

• Partner with Provider Engagement, Network, and Contracting teams to implement clinical quality improvement strategies including education, performance reporting, and workflow improvements that address care gaps and advance quality and member experience goals.
• Analyze provider-level performance data and diverse healthcare data sources to identify improvement opportunities, prioritize care gaps, and translate findings into actionable recommendations and targeted interventions.
• Lead and participate in cross-functional quality improvement workgroups designed to improve HEDIS, CAHPS, and other performance measures with clear action plans and follow-through.
• Collaborate with internal and external stakeholders to advance quality and strengthen member outreach and care-gap closure efforts.
• Lead provider-focused strategies supporting CAHPS/ECHO and other member experience initiatives.
• Maintain documentation of improvement plans, interventions, outcomes, and corrective actions to support applicable quality reporting, audit, and oversight activities.

Required Qualifications

• 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 initiatives.
• Managed care experience, preferably within South Carolina Medicaid.
• Experience analyzing and interpreting healthcare performance data, translating findings into actionable improvement plans, and evaluating intervention results.
• Proficiency in Excel and experience using reporting or visualization tools to analyze and communicate performance trends.
• Strong communication, relationship-building, and stakeholder engagement skills.
• Demonstrated ability to work independently, manage multiple priorities, and execute strategic initiatives with measurable objectives and timelines.

Preferred Qualifications

• Advanced Degree.
• Project management experience leading complex or high-impact initiatives.
• Knowledge of South Carolina Medicaid Managed Care requirements.
• Experience applying structured quality improvement methodologies, such as Plan-Do-Study-Act.
• Certified Professional in Healthcare Quality (CPHQ) or a related quality improvement certification.
• Experience with provider practice workflows, care-gap closure, and clinical data exchange.

Workstyle: Remote work at Home with occasional travel for business to Columbia SC

• Location: Reside within 2 hours of Columbia SC
• Schedule: Monday through Friday 8:30 AM - 5:00 PM Eastern Time
• Travel: 5-10%
• 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.

$78,400 - $107,800 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.