Job Description

Become a part of our caring community and help us put health first

The Senior Stars Improvement Professional is responsible for development, implementation, and management oversight of their assigned provider book of business and providing support to advance Network Performance (NP) strategy and operations. Drives provider engagement, quality improvement programs, NP team engagement and initiatives. The Senior Stars Improvement Professional work assignments involve coordinating, tracking and completion of moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Stars Improvement Professional is responsible for development, implementation, and management oversight of their assigned provider book of business and providing support to advance Network Performance (NP) strategy and operations. Drives provider engagement and quality improvement programs. The Senior Stars Improvement Professional work assignments involve coordinating, tracking and completion of moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

• Articulates and models desired cultural attributes

• Supports Stars narrative with backup data / material

• Prioritize and address financial, RA, clinical and interoperability opportunities in concert with Stars

• Drive YOY performance improvement within their assigned ‘Book of Business’

• Identifies areas of strength and opportunity for a provider Group / TIN and packages to share

• Develop and deliver a clear, strong message that invokes the appropriate response

• Utilize critical thinking to prioritize provider group / TIN, and the provider performance opportunities, based on performance value / opportunity

• Establishes and maintains effective working relationships

• Evaluate provider current state willingness to work with Humana to improve performance, identify improvement plan and escalate as appropriate

• Identify provider best practices and needs, disseminate for sharing and / or resolution

• Maintain documentation of provider visit, including focus and performance trending

• Facilitate effective collaboration and communication

• Self-directed and motivated, with proven ability to work independently given general instructions

• Accountable to work, requiring minimal day-to-day direction and supervision

• Comfortable with facilitating virtual and in-person meetings with C-suite/Management Level Executives

Use your skills to make an impact

Required Qualifications:

• Bachelor’s degree or higher in Business, Finance, Health Care or related field

• 2+ years of Medicare and/or Stars experience

• Understanding of CMS Stars program and performance measures

• Demonstrated proficiency with MS Office Suite (Word, Excel and PowerPoint)

• Understanding of metrics and performance trends and ability to identify performance strengths and opportunities

• History of using data to identify and prioritize opportunities and identify data driven solutions

• Persistent and curious. Driven by the why and willing to engage in detective work to seek and uncover causation and solution.

• Prior successful account management experience; proven influencer

• History of taking on roles of increased responsibilities with proven results

• Excellent communication and presentation skills, both virtually and in person

• Possess an ability to lead by influence and garner buy-in among a diverse group of stakeholders

• Organized and able to manage multiple deliverables requiring moderate to complex decision making (i.e., Project management/Account management)

• Excellent organization, collaboration and team player skills

• Detail orientated, forward looking and comfortable working with tight deadlines in a fast paced, dynamic environment

Preferred Qualifications

• Progressive experience in the Health Care industry

• Physician office practice experience or managed care experience

• Previous experience and/or knowledge of Quality Improvement or Process Improvement

• Coding experience

Additional Information

• Workstyle: This is a Remote position to reside in the following states (TX, OK or AR).

• Workdays and Hours: Monday-Friday; 40-hour work schedule CST

• Travel: There is some travel <50% of the time for this role.

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work At Home / Internet Statement:

To 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 recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

SSN Alert: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

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.

$76,800 - $105,800 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Job Tags

Remote job, Weekly pay, Holiday work, Full time, Temporary work, Apprenticeship, Work from home, Home office, Monday to Friday,

Similar Jobs