Become a part of our caring community and help us put health first
 

Health Quality and Stars (HQS) is an organization that is responsible for improving health outcomes and advancing the care experience of our members and provider partners through quality solutions. HQS is committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS).

The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings, health condition management, health outcomes, patient experience, and plan operations.

The AVP, Stars HEDIS Improvement and Operations is responsible for overseeing the implementation, management, and continuous improvement of the Healthcare Effectiveness Data and Information Set (HEDIS) initiatives as part of the CMS Stars Program. This role will focus on enhancing member experience and satisfaction, ensuring compliance with regulatory requirements, and driving strategies to improve HEDIS scores. This highly visible position identifies actions needed to improve clinical outcomes and customer experience based on customer, market, and business needs.  You will partner with and influence leaders throughout the company to deliver results.

Key Responsibilities:

• Serve as an internal expert on HEDIS technical specifications, regulatory changes, and NCQA and CMS guidance

• Develop and execute an improvement strategy to deliver on contract, measure level targets

• Monitor results, identify trends and areas of opportunity, and drive continuous improvement

• Accelerate shared accountability for HEDIS improvement by effectively communicating the strategy to the Enterprise to create alignment, inspire action and deliver tangible results

• Develop and maintain a portfolio of improvement initiatives focused on delivering improved member engagement, preventive screening and clinical outcomes targeting key drivers of performance

• Collaborate with cross-functional teams to design, test, and scale interventions that directly impact Star ratings

• Responsible for initiative performance monitoring and development of deep, holistic operational reporting, with regular executive summary roll-up to Stars leadership

• Lead multiple analytics partners to develop robust reporting informing prioritized opportunities for Quality improvement and experience; requires ability to derive insights from large quantities of data

• Develop strategic recommendations for program evolution and policy advocacy, including written summaries and talking points for engagement with CMS, industry groups, and internal stakeholders

• Oversee budget, vendor relationships and project/ program management

• Lead and develop team of high- performing direct reports

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree
• 8+ years of experience in Medicare Advantage quality, Stars and/or member experience
• Deep understanding of HEDIS technical specifications, Stars weighting, and CMS expectations
• Progressive experience in the healthcare industry, with emphasis on leading and managing teams
• Proficiency in analyzing and interpreting healthcare data and trends
• Strong attention to detail and focus on process and quality
• Ability to operate under tight deadlines
• Experience driving enterprise strategy
• Exceptional communication, collaboration, and influence skills across clinical, business, and policy audiences

Desired Qualifications

• Masters degree

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the bus