DescriptionThe Senior STARS Improvement Professional develops, implements, and manages oversight of the company's Medicare/Medicaid Stars Program. Directs all Stars quality improvement programs and initiatives. The Senior STARS Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Role: Quality Improvement Consultant (RN/LPN)
Location: Federal Way, WA – Puget Sound area
Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.
Ideal Skillset for this position
The ideal candidate for this position will have provider office or clinic experience, working directly with Medicare patients and also have a good understanding of Medicare Advantage plans. Managed care experience is a must. This individual should be up for traveling throughout the Puget Sound area with some Federal Way office based days during the week. Quality/Stars/HEDIS experience is a plus, but not required. This job is provider office facing, educating our providers on best practices for working with our Medicare membership so these members will receive the best care possible.
The Quality Improvement Consultant will facilitate and work collaboratively with provider groups focused on Medicare Advantage plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality. This is an office based position, but does allow for flexibility in location and frequent day travel.
Other responsibilities include:
- Effectively develop, enhance and maintain provider clinical relationship across product lines
- Deliver provider/member-specific metrics (e.g., Star Quality Reports (SQR), Member on a page, Anvita alerts) and coach providers on quality gap closing opportunities for Humana members
- Successfully promote practice-patients’ participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement
- Accurately define gaps in Humana’s service relationship with providers and facilitate resolution
- Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support
- Review medical records and identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture, use SQR to identify information and provide guidance to practice)
- Effectively coach provider office staff on best means to communicate with Senior members that may have hearing, vision, physical abilities challenges (i.e. Perfect Service orientation)
- Desire to consult and influence providers to improve practice processes that enhance care
- Experienced clinical background as an RN or LPN
- Strong analytic skills and ability to use data to drive improvement activities
- Strong understanding and ability to read medical charts and use EMRs in order to identify evidence of care and improvement opportunities
- Strong organizational and prioritization skills with ability to collaborate with multiple departments in a team environment
- Detail orientated and comfortable working with tight deadlines in a fast paced environment
- Ability to work independently under general instructions, self-directed and motivated
- Excellent PC skills (including MS Word, Excel and PowerPoint)
- Managed Care experience and understanding of value-based care model
- This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10Mx1M
- Strong knowledge of HEDIS/Stars/CMS/Quality
- Previous health plan operations experience
- Knowledge of medical coding
This role reports to the Quality Director
This role will work closely with Market/Region MRA, Clinical and Provider Engagement Staff.
This is an in-office role with 25% regional travel
Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Scheduled Weekly Hours40