Senior Network Professional

Overview

The Senior STARS Improvement Professional develops, implements, and oversees the execution of regional markets Medicare/Medicaid Stars quality improvement programs and initiatives. This role examines complex data, recommends strategies, and executes to improve overall Star ratings and provider engagement.

• Develop programs to increase plans’ Star ratings and improve quality outcomes.
• Partner with leaders for implementation planning and communicate program results.
• Influence department strategy and make decisions on moderately complex technical approaches.
• Exercise considerable latitude in determining objectives and approaches for assignments.
• Build relationships with physician groups and influence execution of recommended strategy.

• Experience with Medicare and/or managed care.
• Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system.
• Knowledge of interoperability and patient experience.
• Process and quality improvement focus; ability to identify gaps in care.
• Strong communication and presentation skills, both verbal and written; experience presenting to internal and external customers, including high‑level leadership.
• Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.
• Bachelor's degree in Business, Finance, Health Care/Administration, RN, or related field, or equivalent work experience.
• Progressive experience with interoperability solutions in healthcare and Medicare Risk Adjustment and/or medical coding.
• Organizational and prioritization skills; ability to collaborate across multiple departments.

• Experience with Medicare Risk Adjustment and/or medical coding.

Remote work with Home/Hybrid Home/Office arrangement. Internet requirements: minimum download speed 25

Mbps, upload 10

Mbps. Dedicated workspace is required; occasional travel to Humana offices for training or meetings may be required.

Pay range: $78,400 – $107,800 per year; eligible for a bonus incentive plan.

• Medical, dental, and vision coverage.
• 401(k) retirement savings plan.
• Paid time off (including holidays, parental and caregiver leave).
• Short‑term and long‑term disability.
• Life insurance.

Humana, Inc. is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. Humana also takes affirmative action and base employment decisions only on valid job requirements.