Louisville, Kentucky-based Humana offers a wide range of insurance products and health and wellness services. Humana is dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Humana associates are at the heart of creating and providing positive healthcare experience for its members. The firm is seeking innovative professionals who are passionate about making a positive change in the lives of others. Humana recruits undergraduate and graduate level students for internships and full-time opportunities, and is devoted to hiring veterans in all areas of its business as well. When joining the team, you will have the chance to benefit from a bunch of incentives including a competitive base pay, medical, dental and vision benefits, life insurance, 401(k), paternity leave, and several other.
The Senior STARS Improvement Clinical Professional develops, implements, and manages oversight from a clinical and strategic perspective for the company's HEDIS/Pharmacy areas, which is a contributor to the measures affecting Medicare/Medicaid Stars Program. This role would lead clinical initiatives and strategies that would direct some of the Stars quality improvement programs. The Senior STARS Improvement Professional work assignments will involve moderately-complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors, yielding a comprehensive approach to impact these. This role would also collaborate and enhance results as part of the MSO strategy goals.
This position is based from a home office with 50% travel in the state of FL. You must live in FL to be considered for this position.
The Senior STARS Improvement Professional develops programs designed to increase the plan quality. Partners with leaders regarding implementation planning. Reviews and communicates results of programs. Begins to influence department's strategy. Provides education tools and scripted strategies to teams, which interact with network providers, of quality outcomes based on HEDIS, Part D safety measures. Retrieves data from multiple databases and communicates findings from reports to those that communicate to providers. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Travels locally at a rate of approximately 50% within territories covered by plan membership.
+ RN with HEDIS/STARS background
+ 3+ years of experience in the healthcare or wellness solutions industry
+ Strong attention to detail and focus on process and quality
+ Excellent communication skills
+ Ability to operate under tight deadlines
+ Willingness and ability to travel locally at a rate of approximately 50%
+ Proficient in Microsoft Office applications, including Word, Excel, Outlook and PowerPoint
+ Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
+ TB screen is required if selected for this position
+ Bachelor's Degree in Health Care or a related field
+ Prior Medicare/Medicaid experience
+ Nursing background familiar with clinical PCP workflow and clinical processes
+ Prior managed care experience
+ Understanding of metrics, trends and the ability to identify gaps in care/analytical background
+ 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
As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.
If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.
Scheduled Weekly Hours
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms -when and where they need it. Our employees are at the heart of making this happen and that's why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
Equal Opportunity Employer
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