[Hiring] STARS Improvement Professional 2 @Humana

Role Description

The STARS Improvement Professional 2 develops, implements, and manages oversight of the company's Medicare/Medicaid Stars Program. Directs all Stars quality improvement programs and initiatives. The STARS Improvement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• Develops programs designed to increase the plan quality.
• Partners with leaders regarding implementation planning.
• Reviews and communicates results of programs.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

General Duties/Responsibilities:

• Review provider/member-specific UM and QI metrics and coach assigned providers (center/group less than 150 members) on gaps of care opportunities through virtual/telephone/email.
• Provide resources and educational opportunities to providers and staff.
• Promote practice-patients’ participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement.
• Identify specific practice needs (e.g. use of most efficient interaction channel) to provide support.
• Educate providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.

Qualifications

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

Requirements

• To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
  • In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Humana, Inc. and its affiliated subsidiaries offer 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.
• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.