Humana

About Humana

 

Job Category:

Member Quality & Financials - Risk Adjustment & STARS operations

Country:

United States

Approximate Salary:

Not Specified

Position Type:

Full Time

Senior Stars Improvement Professional - New Orleans

Humana - Work At Home, Louisiana

Posted: 12/14/2018

Description

The Senior Stars Improvement Professional implements and manages oversight of the region's Medicare Stars Program. Executes and supports 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 develops programs designed to increase the plan quality. Partners with provider engagement and Medicare Risk Adjustment education teams regarding goal setting, strategy and action plan implementation. Reviews and communicates results of programs.

  • Works at clinic and provider level with primary focus on education.  Creates and supports a strategy/action plan individualized to each provider group for Stars initiatives.
  • Provides clinic and provider level familiarization and insights.
  • Assists providers with quality gap closure by conducting medical record audits, retrieving medical records, and/or extracting data from the provider’s electronic medical record. 
  • Analyzes provider level data, distributes and creates reports to focus provider efforts on high opportunity quality measures.
  • Outreaches members to counsel/educate, promote special events or assist with resolving barriers to compliance. 
  • Begins to influence the department’s strategy by identifying and sharing best practices based on quality outcomes.

               

Required Qualifications

  • Bachelor's Degree in Business, Finance, Health Care or a related field
  • 5+ years of technical or clinical experience
  • Prior Medicare/Medicaid experience
  • Strong attention to detail and focus on process and quality
  • Excellent communication skills
  • Ability to operate under tight deadlines
  • Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint

Preferred Qualifications

  • An active Registered Nurse (RN) License free of restrictions
  • Master's Degree in Business Administration, Health Administration or a related field
  • Progressive experience in the health solutions industry
  • Prior managed care, physician practice or population health management experience
  • 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
  • Understanding of CMS Stars, performance measures, HEDIS knowledge and experience
  • Background working in quality or performance improvement
  • Coding experience a plus

Additional Information

  • Requires moderate travel in New Orleans metro

Scheduled Weekly Hours

40

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