The STARS Improvement Professional 2 develops, implements, and manages oversight of the company's Medicare/Medicaid Stars Program. Directs all Stars quality improvement programs and initiatives. The STARS Improvement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The STARS Improvement Professional 2 develops programs designed to increase the plan quality. Partners with leaders regarding implementation planning. Reviews and communicates results of programs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
General Duties/Responsibilities:
- Review provider/member-specific UM and QI metrics and coach assigned providers (center/group less than 150 members) gaps of care opportunities through virtual/telephone/email.
- Provide resources and educational opportunities to providers and staff.
- Promote practice-patients' participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement.
- Identify specific practice needs (e.g. use of most efficient interaction channel) to provide support.
- Educate providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.
Required Qualifications- Bachelor's Degree in Business, Finance, Health Care or a related field
- 2+ years of clinical experience
- Prior Medicare/Medicaid experience
- Strong attention to detail and focus on process and quality
- Excellent communication skills
- Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
Preferred Qualifications- Master's Degree in Business Administration, Health Administration or a related field
- Progressive experience in the health solutions industry
- Prior managed care experience
- Understanding of metrics, trends and the ability to analyze and identify gaps in care
- Experience with SQL which includes the ability to create reports from scratch and also run existing reports
- Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus
- Understanding of CMS Stars, performance measures, HEDIS knowledge and experience a plus
- Background working in quality improvements
Work at Home RequirementsTo 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours40
Pay RangeThe 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.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, 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.
