Senior STARS Improvement Professional

Profile

Description

The Senior STARS Improvement Professional develops, implements, and manages oversight of the company's Medicare/Medicaid Stars Program. Directs 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 leaders regarding implementation planning. Reviews and communicates results of programs. Begins to influence department's strategy. Provides education to network providers of quality outcomes based on HEDIS, Part D safety measures and CAPS and HOS surveys. Retrieves date from multiple databases and communicates findings from reports 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.

Required Qualifications

Associate's Degree

3 years of experience in the healthcare or wellness solutions industry

1 years of experience with CMS Stars

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

Preferred Qualifications

Bachelor's Degree in Business, Finance, Health Care or a related field

Prior Medicare/Medicaid experience

Nursing/Clinical background preferred, but not required, with clinical PCP workflow and processes

Prior managed care 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 performance measures and HEDIS knowledge a plus

Coding experience a plus

Additional Information

Travels locally at a rate of approximately 50% within territory which could include Jacksonville, Daytona, and Tampa.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com