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

Profile

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 strategies and initiatives designed to increase the plan quality. Partners with external and internal stakeholders including Bold Goal, Corporate Partners, and market level teammates (provider engagement and Medicare Risk Adjustment) regarding goal setting, strategy and action plan implementation. Reviews and communicates results of programs.

Work from home and in target communities to design, execute, and evaluate programing using Project Management Framework

Create and maintain partnerships that drive quality outcomes

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 provider's 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 department's strategy by identifying and sharing best practices based on quality outcomes.

Required Qualifications

Bachelors Degree

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

Prior business writing and designing of process and marketing material

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 or MSW 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

Company info

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