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

The Director, Quality and Risk Adjustment has regional oversight of the development and implementation of the company Medicare/Medicaid Stars Program. Oversees Stars quality improvement programs and initiatives to increase the plan quality. Has regional oversight of risk adjustment to ensure appropriate implementation of programs and data quality that is submitted to CMS and other governmental agencies. The Director, Quality and Risk Adjustment requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

               

The Director, Quality and Risk Adjustment, a member of the Regional Leadership team reporting to the Regional President, is responsible for the successful execution of Stars and Risk Adjustment strategy and performance within a designated region. Identifies regional nuances that have provider impact combined with an operational mindset. This opportunity requires the ability to effectively partner across the Region and with the Corporate Stars and MRA organizations, a highly inclusive leadership style, and the ability to lead and develop a team with diverse experience. The Director, Quality and Risk Adjustment implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

Use your skills to make an impact
 

Required Qualifications:

• Bachelor's Degree
• Proven ability to develop and operationalize strategy
• 3+ years of Stars and/or Risk Adjustment programs experience
• Ability to influence market strategy and decisions based on Stars and Risk Adjustment considerations
• 3+ years of experience directly leading and developing teams
• Provider engagement/Provider experience
• Ability to lead through influence
• Understanding of interoperability solutions (i.e., EMR)
• Proficiency in analyzing and interpreting data trends with the ability to understand and effectively anticipate business impact
• Strong written and verbal communication skills
• Proficiency in Microsoft Office applications
• Demonstrated ability to efficiently operate within tight timelines and to pivot as business needs dictate
• This is a remote position, but candidate must live in the state of Florida.

Preferred Qualifications:

• Knowledge of Stars and CMS quality measures
• Advanced degree
• Strong financial acumen
• Previous experience in a health solutions organization

Work-At-Home Requirements

• Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.