Stars - Quality Improvement Professional

Join 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.

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

• Bachelor's Degree
  • Prior LPN/LVN, Lead Medical Assistant or Center Administrator experience.
• Knowledge of Humana's internal policies, procedures, and systems.
• 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

• 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 $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…