Senior Stars Improvement Professional - Southern New Mexico territory Work at Home with some Travel must reside in NM

Profile

Description

The Senior Stars Improvement, Clinical Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve quality performance. The Senior Stars Improvement, Clinical 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 and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve quality performance. Work assignments involve moderately complex-to complex issues; work is performed autonomously.

How we Value You:

Benefits starting day one of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parental Leave

Go365 perks for well-being

Responsibilities

The Senior Stars Improvement Professional's work focuses on relationship management, influencing provider group strategy and achieving regional goals.

Coach assigned provider groups and MSO groups on gap closing opportunities and improving quality outcomes via in-person/virtual/telephone meetings.

Review provider/member-specific UM and QI metrics

Provide resources and educational materials to providers and staff

Review medical records or claims to identify needed improvements to impact HEDIS measures (i.e. identify deficiencies in data capture and provide guidance).

Prepare Power Point slide content and present at meetings.

Educate providers and staff about CMS Stars program, HEDIS, CAHPS, HOS.

Required Qualifications

Bachelor's Degree in Healthcare, Business, related field

3-5 years of experience in healthcare, clinical, Quality or Stars

Managed care experience and understanding of value-based care model

Strong analytic skills, ability to use data to drive improvements

Strong presentation (oral and written) & relationship-building skills

Ability to operate under tight deadlines in fast-paced environment

Ability to work independently under general instructions; self-directed and motivated

Proven organizational and prioritization skills; ability to collaborate with multiple remote departments in a team environment

Excellent PC skills, including Word, Excel, PowerPoint and Outlook

Ability to travel locally/regionally throughout NM, 30-40%

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

Nursing or operations background, familiar with clinical/PCP workflow and processes

Understanding of CMS Stars program including HEDIS, CAHPS/HOS

Experience in provider relations, health plan operations or quality improvement

Additional Information

To be considered for this role you must live in New Mexico and be willing to travel locally to provider offices throughout the state, up to 40% of the time with some overnight stays

Currently this position is not doing any traveling as we adhere to our company travel restriction policy due to COVID-19.

As the Covid-19 environment changes and we return to normal business operations, this person will continue to work from home and be required to do local travel to provider offices within the New Mexico area up to 40% of the time with some overnight stays.

Scheduled Weekly Hours

40

Company info

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