STARS Improvement Professional 2

Humana • Work at Home - Florida, FL

11d • $71,100 - $97,800 • Remote

About The Position

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. The STARS Improvement Professional 2 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.

Requirements

• 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

Nice To Haves

• Master's Degree in Business Administration, Health Administration or a related field
• Progressive experience in the health solutions industry
• Prior managed care experience
• Understanding of metrics, trends and the ability to analyze and identify gaps in care
• Experience with SQL which includes the ability to create reports from scratch and also run existing reports
• Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus
• Understanding of CMS Stars, performance measures, HEDIS knowledge and experience a plus
• Background working in quality improvements

Responsibilities

• Review provider/member-specific UM and QI metrics and coach assigned providers (center/group less than 150 members) 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.

Benefits

• medical
• dental
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level