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
Assignment: Senior Products
Location: Federal Way, WA
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.
The Quality Improvement Consultant will facilitate and work collaboratively with provider groups focused on Senior Products, Commercial and Medicaid plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality. This is an office based position, but does require 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 quality of care for patients
- 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
- Strong knowledge of HEDIS/Stars/CMS/Quality
- 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)
- 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.
- Managed Care experience and understanding of value-based care model
- Previous health plan operations experience
- Knowledge of medical coding
Reporting Relationships This role reports to the Quality DirectorAdditional InformationThis 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.
Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice 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.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours40