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/Special Project Consultant
Location: Work at home, El Paso, TX
The Quality Improvement/Special Project Consultant will facilitate and work collaboratively with provider groups focused on Senior Products, Commercial and Medicaid plans to guide, document and track practice specific strategies designed to improve all aspects of Stars and Quality.
- 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 clear and concise 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
- Manage development, execution and performance oversight of new Stars initiatives
- Facilitate regular status meetings with business owner/project teams/steering committees
- Report progress of project deliverables and milestones
- Bachelor’s Degree in Healthcare, Business or other related field
- Prior successful account management experience in a fast paced environment
- 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, strategic and prioritization skills with ability to collaborate across multiple departments
- Comfortable working on new projects with limited knowledge/expertise of the content and be able to learn quickly in order to effectively manage the implementation.
- Detail orientated, forward looking and comfortable working with tight deadlines in a fast paced, dynamic environment
- Previous experience planning and managing medium/large scale projects
- Demonstrated proficiency with MS Office Suite (Word, Excel, PowerPoint, Outlook, and Visio)
- 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 for Humana systems is 10Mx1M
- Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.
- Experienced clinical background as RN or LPN
- Knowledge of CMS Stars Program elements, including HEDIS, Patient Experience and Patient Safety
- 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
- SharePoint designer
- This position reports to a Stars Quality Clinical Operations Manager
- Work at Home role traveling 75% of the time
- This role works closely with Market Operations, MRA, HSO and Clinical teams
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.
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