Description

We are seeking a driven individual to support the Stars program to positively impact HEDIS measure performance accounting for significant impact to Star rating performance through delivery of key insights, strategic initiatives, and operational excellence. The role will support key program initiatives with project implementation, clinical expertise, and performance oversight to deliver and advance Stars strategy. A broad range of skills including strategic thinking, data interpretation, and program management will be required.

Responsibilities

Location: remote (If in driving distance to Louisville office, role will be hybrid which is a combination of in office and work at home)

Apply in-depth and broad knowledge of HEDIS measures to develop strategy and implement projects for complex measures to drive overall Stars performance

• Accountability for performance of lagging and complex HEDIS measures critical to Humana’s ability to improve Star ratings

• Partner with multiple analytics teams to develop, prioritize, and deliver solutions to problems across challenging measures

• Proactively engage the right stakeholders to anticipate headwinds and identify gaps with new measures or changing specifications, looking ahead to implement solutions to prevent negative impact to performance

Provide insights and identify new opportunities for improvement through data analysis of variable factors to determine course of action

• Ability to make recommendations based on reporting and monitoring by contract, region, provider and aggregate performance, identifying where things are going well and why, as well as where things need to improve and how

• Cross-collaboration with performance management team to interpret and deliver key recommendations to achieve Stars goals

Conduct audits of all data collection and processes to ensure operational excellence across the team

• Create standard operating procedures, document data collection, and establish processes for audit and quality control

• Identify gaps and new opportunities to utilize data to improve performance

Drive key initiatives that impact Stars measure performance goals

• Understand goals and apply to the execution and performance oversight of initiatives key to Stars success

• Influence teams across the enterprise to deliver and prioritize work impacting our goals, providing education and ongoing evaluation

Support key functions with strategic and analytical thinking

• Requires a general understanding of Stars operations and ability to effectively communicate the Stars story

• Knowledge of the technical specifications and codes within attributed value sets

• Detail oriented and willing to learn the more minute parts of HEDIS measures and gap closure processes with limited guidance and direction

• Use problem solving skills to resolve issues and make decisions in a fast pace, complex, ever-changing environment

• Understand campaign development to provide insights for new concepts, technologies or processes

• Experience with market needs to provide insights to improve performance in key contracts and regions

• Understanding of or experience with clinical setting to advance provider first strategies, influence member interventions and identify new opportunities to impact

Required Qualifications

• Bachelor’s Degree or equivalent work experience

• 8+ years of strategy, quality and/or operations experience

• 2+ years of project leadership experience

• Medicare Stars knowledge or experience

• Program management experience

• Superb communication skills, written and verbal

• Experience leading special projects and producing metrics, measurements and reports

• Proficiency in interpreting data trends and applying to engagement strategy

• Comfortable working independently to accomplish components of a larger program

• Strong organizational and time management skills

• Must be comfortable communicating results to senior leadership

Desired Qualifications

• Master’s degree

• Clinical experience

• HEDIS experience

Additional Information

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.

This is a remote position

#LIremote

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$102,200 - $140,675 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.