Humana · 7 hours ago
Quality Performance Lead - Medicare / ACO
United States
Full-time
Remote
Mid, Senior Level
$104K/yr - $143K/yr
5+ years expHumana is a healthcare company that focuses on providing proactive, preventive care to seniors. The Medicare Quality Lead will be responsible for overseeing quality measurement and reporting activities, ensuring compliance with CMS quality programs, and leading continuous quality improvement initiatives across various teams.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Own quality strategy for the ACO; align to CMS program requirements and organizational goals
Translate CMS quality measures into actionable clinical and operational workflows
Lead annual quality planning, goal setting, and performance forecasting
Serve as the main internal subject matter expert on ACO quality programs
Oversee quality reporting for MSSP (eCQMs, CAHPS, administrative measures)
Oversee quality reporting for ACO REACH / LEAD (quality withhold / earn-back accountability and performance measures)
Oversee MIPS / APM quality reporting for non-qualified APM / ACO participants
Ensure compliance with CMS technical specifications, submission deadlines, and audit requirements
Coordinate w/ quality registry to ensure accurate on-time submission; validate output
Lead CMS audits, data validation, and corrective action plans
Monitor measure performance at ACO, practice, and patient levels
Develop and monitor KPIs
Work closely with operations and provider engagement teams to identify and close gaps
Interpret performance trends and communicate insights to executive leadership
Design and implement quality improvement initiatives (i.e. preventive care, chronic disease management, care transitions) - align clinical programs / interventions to measures that materially impact performance
Collaborate with care management, population health and informatics teams embed quality into workflows
Use data-driven interventions to close care gaps and improve patient outcomes
Educate providers and provider engagement teams on quality measures and documentation requirements
Surface performance results and improvement opportunities
Provide performance updates and training sessions, as needed
Assure that standards of practice and policies are compliant with the ACO contractual requirements and other contractual and regulatory guidelines and standards
Ensure ACO programs are administered and configured and loaded properly; oversee key operational processes; identify opportunities for performance improvement, and provide regular performance updates
Oversee ACO wholly owned participant provider segment including key processes, programs, and performance; liaise with market teams
Manage ACO governance process, including the Center Well ACO Board
Provide ACO strategy and planning support; coordinate closely with M&A team on ACO integration planning for acquired provider groups
Prepare executive level presentations that highlight business performance and opportunities
Develop, prepare, and interpret reports. Write basic SQL queries to pull data and build reports. Coordinate with Business Intelligence Lead and support ad hoc reporting
Develop basic modeling and business case analysis, work closely with Finance and Data teams
Coordinate with ACO Lead overseeing the IPA / Affiliate business segment
Adept at forming strong relationships with diverse teams and personalities through effective trust building and collaboration; highly organized, demonstrated ability to show meticulous attention to detail
Qualification
Required
Bachelor's degree required; master's degree preferred (MPH, MHA, MBA, or related)
5+ years of experience in healthcare quality, population health, or value-based care
Direct experience with CMS ACO quality programs (MSSP and / or ACO REACH) strongly preferred)
Deep knowledge of CMS quality measures, specifications, and quality reporting (eCQM / CQM)
Familiarity with EMR systems and quality reporting workflows
Strong understanding of value-based payment models and shared savings mechanics
Familiarity with healthcare industry including value-based care, health plans, health systems, Medicare, accountable care, population health, medical group management / practice management, or Management Service Organizations (MSOs)
Preferred
Nursing licensure preferred (RN, LPN)
Experience leading quality programs for large group practice or ACO
Benefits
Medical
Dental and vision benefits
401(k) retirement savings plan
Paid time off
Company and personal holidays
Volunteer time off
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Caleb Gallifant
Chief Operating Officer, CenterWell Home Health
Recent News
2026-02-03
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