Humana

About Humana

 

Job Category:

Member Quality & Financials - Risk Adjustment & STARS operations

Country:

United States

Postal Code:

33023

Approximate Salary:

Not Specified

Position Type:

Full Time

Senior STARS Improvement Professional

Humana - Miramar, Florida

Posted: 12/10/2018

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

The Senior STARS Improvement Professional will facilitate and work collaboratively with the regional departments, providers and partners focused on Medicare Senior Products to guide, recommend and develop specific strategies designed to improve all aspects of member experience and improve the regions CAHPS & HOS performance and survey results. 

  • Effectively develop, enhance and maintain provider relationships
  • Deliver provider/member-specific metrics and coach providers on member experience and health outcomes opportunities
  • Successfully promote patients’ participation in CAHPS & HOS  programs - providing information on participation and partner with providers
  • Accurately define gaps in member experience/member relationship with providers and facilitate resolution
  • Identify specific practice needs to provide support
  • Review provider facilities and systems to identify needed improvements that impact CAHPS & HOS  measures
  • Effectively coach/support  provider office staff on best practices to communicate with Senior patients that may have hearing, vision, physical abilities challenges
  • Support diverse quality improvement projects and initiatives to improve patients’ education and patients’ satisfaction

               

Required Qualifications

  • Bachelor's Degree
  • 5+ years of experience working in a health plan, provider office or hospital setting
  • Understanding of CMS Stars, performance measures, CAHPS/HOS  knowledge and experience
  • Strong attention to detail and focus on process and quality
  • Excellent presentation and communication skills
  • Ability to operate under tight deadlines
  • Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
  • Valid Driver's license with reliable transportation and the ability to travel up to 75% within the region (Broward, Miami-Dade, Palm Beach Counties)

Preferred Qualifications

  • Master's Degree in Business Administration, Health Administration or a related field
  • Progressive experience in the health solutions industry
  • Previous quality or process improvement experience in a hospital or physician office practice
  • Understanding of metrics, trends and the ability to identify gaps in care
  • Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus
  • Background working in quality improvements
  • Health Education background is a plus

Scheduled Weekly Hours

40

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