Stars - Quality Improvement Professional

Become a part of our caring community

The Stars Quality Improvement Professional will support clinicians and staff, working collaboratively with the staffed clinical and operations teams including center administrators. Provide support, make recommendations and help implement quality improvement best practice programs designed to improve CMS Star measures (HEDIS), patient safety and patient experience (CAHPS-HOS). Quality Improvement Professional assignment may be coverage of PCO staffed providers and PCO Independent Network provider/practices functioning in a similar capacity as described previously for support to the staffed centers. Best suited candidate will have an interest and practical experience working with clinical Star measures in particular medication adherence and HEDIS. You will need to work in and around our Las Vegas clinics 4 out of 5 days.

• Utilize approved avenues to outreach to patients with medication reminders
• Medical record review, retrieval, and submissions to health plans to support HEDIS gap closure.
• Distribute time-sensitive and relevant data to promote action on the part of clinical teams and operations to address opportunities and close gaps (excel moderate -to- advanced skills)
• Review and assess provider/member detail HEDIS data/gap reports to identify opportunities for improvement and gap closure.
• Leads efforts to identify opportunities for improvement, workflow deficiencies and barriers.
• Develop and implement strategic action plans to achieve annual Stars goals within market and/or centers
• Provides support to provider/practice specific needs thus assisting in driving the effective implementation of the quality improvement strategy.
• Manage workloads such as the distribution of medication adherence reports to PCP.
• Train/educate teams on CMS Star measures, one-on-one or in a setting with multiple team members (clinicians, medical assistants, practice administrators, front office).
• Present Stars performance information during meetings one-on-one or in wider settings. Create PowerPoint presentation.
• Collaborates with various stakeholders/partners (internal and external) including market operations/provider relations, coding teams; medical directors, clinical and health plan teams, and vendors to provide support and in some cases assist with the execution of workflows developed to improve outcomes for HEDIS, patient safety (such as medication adherence) and patient experience. • Support quality initiatives events such as eye screenings, bone mineral density, etc.

Use your skills to make an impact

Required Qualifications

• Strong understanding of healthcare STARS measures (HEDIS, Patient Safety, andPatient Experience (CAHPS/HOS) in particular knowledge of the measure technicalspecifications.
• 2 + years' experience working with CMS Stars measures.
• Prior experience in a health care setting direct hands-on patient care, front office orprovider relations field.
• Experienced providing training 1:1 or in a group setting.
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint andexcellent communication and presentation skills
• Must be willing to travel locally, to our CenterWell Nevada market.

Preferred Qualifications

• Bachelor's Degree • Prior LPN/LVN, Lead Medical Assistant or Center Administrator experience.
• Knowledge of Humana's internal policies, procedures, and systems. Additional Information:
• Work schedule: M-F, 8AM-5PM. Occasional after 5PM meetings
• Work-at-home and visits to medical centers and or IPA offices
• Must reside in Las Vegas area

Additional Information

• To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self- provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.

Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$53,700 - $72,600 per year

Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.​ 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.