6 days old

Senior Stars Improvement Professional/Project Mgr - WAH Louisiana/Mississippi

Humana
Metairie, LA 70001
Description The Senior Stars Improvement Professional/Project Manager implements and manages oversight of the region's Medicare Stars Program. Executes and supports all Stars quality improvement programs and initiatives. The Senior Stars Improvement Professional/Project Manager 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/Project Manager develops programs designed to increase the plan quality. Partners with provider engagement and Medicare Risk Adjustment education teams regarding goal setting, strategy and action plan implementation. Reviews and communicates results of programs. + Work from home performing chart audits and medical reviews + Provides clinic and provider level familiarization and insights. + Assists providers with quality gap closure by conducting medical record audits, retrieving medical records, and/or extracting data from the providers electronic medical record. + Analyzes provider level data, distributes and creates reports to focus provider efforts on high opportunity quality measures. + Outreaches members to counsel/educate, promote special events or assist with resolving barriers to compliance. + Begins to influence the departments strategy by identifying and sharing best practices based on quality outcomes. Required Qualifications + 3+ years of project management experience + Medicare/Medicaid experience + Strong attention to detail and focus on process and quality + Excellent communication and project management skills + Ability to operate under tight deadlines + Comprehensive knowledge of all Microsoft Office applications, including Word, Excel (must know advanced functions like VLookups./Pivot Tables, etc.) and PowerPoint Preferred Qualifications + An active Registered Nurse (RN) License free of restrictions + Master's Degree in Business Administration, Health Administration or a related field + Progressive experience in the health solutions industry + Prior managed care, physician practice or population health management experience + Understanding of metrics, trends and the ability to identify gaps in care + Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus + Understanding of CMS Stars, performance measures, HEDIS knowledge and experience + Background working in quality or performance improvement + Coding experience a plus Additional Information Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>

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Posted: 2020-03-23 Expires: 2020-04-22

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Senior Stars Improvement Professional/Project Mgr - WAH Louisiana/Mississippi

Humana
Metairie, LA 70001

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