Humana

About Humana

 

Job Category:

Member Quality & Financials - Risk Adjustment & STARS operations

Country:

United States

Postal Code:

75014

Approximate Salary:

Not Specified

Position Type:

Full time

Quality Improvement Consultant - Work at home, Dallas/Fort Worth, TX area (Richardson, Frisco, Allen, Plano, McKinney)

Humana - Irving

Posted: 07/4/2018

Description

The 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.

Responsibilities

Role:                      Quality Improvement Consultant
Assignment:         Medicare
Location:               Work at home - Dallas/Fort Worth, TX area

Assignment Capsule

The Quality Improvement Consultant will facilitate and work collaboratively with provider groups focused on Senior Products, Commercial, Medicare and Medicaid plans to guide, document and track practice specific strategies designed to improve all aspects of Stars and Quality.

Ideal Skillset

This is a work at home position in the Dallas/Fort Worth market of Richardson, Frisco, Allen, Plano, McKinney and surrounding vicinities.  This individual will spend about 75% of their time in the field visiting providers offices.  The ideal candidate will be self-driven, motivated, outgoing and a real go getter.  HEDIS experience and a quality background are a plus.  Strong computer skills are needed in this role with a good working knowledge of Excel.  Teamwork and ability to collaborate within a workgroup is the key and success to this role.Responsibilities include:

  • Critical thinking to prioritize PCP outreach based on what will deliver greatest return on investment (i.e. who to outreach, frequency of outreach, visit focus, communication method / collateral)
  • Evaluate provider current state willingness to work with Humana to improve Stars performance and tailor messaging accordingly
  • Identify key point of contact for each prioritized PCP and effectively develop / enhance provider clinical relationship across product lines.  Accurately define gaps in Humana’s service relationship with providers and facilitate resolution through Service Alignment Manager (SAM)
  • Deliver provider/member-specific metrics and supporting collateral (e.g., HEDIS Summary, Patient Experience, Rx Opportunity, etc.) and coach providers on improving all aspects of Stars performance
  • Educate PCP’s on Stars program, changes and best practices to enhance all aspects of Stars performance
  • Identify provider best practices and needs, disseminate for sharing and / or resolution
  • Maintain documentation of provider visit, including focus and performance trending (Quality Journal)
  • Facilitate effective collaboration and communication with workgroup members (including operations, clinical and MRA) and Stars and Quality team members
  • Identify opportunities to improve Stars and Quality processes, methods, team engagement, etc. and present resolution options / cost

               

Role Essentials

  • Associate’s or Bachelor’s Degree in  Healthcare, Business or other related field
  • Prior successful account management experience
  • History of taking on roles of increased responsibilities with proven results
  • Self-directed and motivated, with proven ability to work independently given general instructions
  • Strong communication and public speaking skills; proven influencer
  • Strong organizational and prioritization skills with ability to collaborate across multiple departments
  • Detail orientated, forward looking and comfortable working with tight deadlines in a fast paced, dynamic environment
  • Demonstrated proficiency with MS Office Suite (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.
  • 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

Role Desirables

  • Experienced clinical background as RN or LPN
  • Knowledge of CMS Stars Program elements, including HEDIS, Patient Experience and Patient Safety
  • Strong Communication and Collaborative/Teamwork Skills and abilities
  • Physician office practice experience
  • Previous experience and/or knowledge of Quality Improvement or process improvement
  • Strong analytic skills and ability to use data to drive improvement activities
  • Previous Health Insurance clinical or operations experience

Reporting Relationships

  • This role reports to the Frontline Leader, Manager and Quality Improvement Director.

Additional Information

  • Work  at Home role traveling 75% of the time
  • This role works closely with Market Operations, MRA, HSO and Clinical teams

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 Hours

40

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