Become a part of our caring community and help us put health firstThe Director, Quality and Risk Adjustment has regional oversight of the development and implementation of the company Medicare/Medicaid Stars Program. Oversees Stars quality improvement programs and initiatives to increase the plan quality. Has regional oversight of risk adjustment to ensure appropriate implementation of programs and data quality that is submitted to CMS and other governmental agencies. The Director, Quality and Risk Adjustment requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

The Director, Quality and Risk Adjustment, a member of the Regional Leadership team reporting to the Regional Vice President of Provider Performance, is responsible for the successful execution of Stars and Risk Adjustment strategy and performance within a designated region. Identifies regional nuances that have provider impact combined with an operational mindset. This opportunity requires the ability to effectively partner across the Region and with the Corporate Stars and MRA organizations, a highly inclusive leadership style, and the ability to lead and develop a team with diverse experience. The Director, Quality and Risk Adjustment implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

• Responsible for 3 direct and 30 indirect reports including Manager, Stars Improvement and Stars Improvement Professionals
• Responsible for developing and implementing strategies to increase interoperability of data working with established EMR systems, and vendor solutions
• Works closely with the Provider Engagement team to provide support for Quality and Risk Adjustment functions as a subject matter expert
• Partners w/ Director Provider Engagement to influence provider relationships and performance outcomes
• Works with Corporate Risk Adjustment, Quality, and Interoperability teams
• Implements strategic plans, drives goals and objectives, and improves performance

Desired Skillset:

• Experience aligning goals to strategy, organize resources, prioritize initiatives
• Collaborative. Ability to execute within matrix-style organizational structure.
• Demonstrated ability to efficiently operate within tight timelines and to pivot as business needs dictate
• Ability to lead through influence

Use your skills to make an impact

Required Qualifications:

• Bachelor's Degree
• Prior experience in market strategy and decisions based on Stars and Risk Adjustment
• 3 years of experience directly leading and developing teams
• Provider engagement/Provider performance experience
• Prior experience in analyzing and interpreting data trends with the ability to understand and effectively anticipate business impact

Preferred Qualifications:

• 3 years of Stars and/or Risk Adjustment programs experience
• Knowledge of Stars and CMS quality measures
• Knowledge of CMS Medicare Risk Adjustment model
• Advanced degree
• Strong financial acumen
• Previous experience in a health solutions organization

Additional Information

Location: NY, PA, MD, NJ, KY preferred

Work at Home/Remote Requirements

Work-At-Home Requirements

• 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 to support Humana applications, per associate.
  • Wireless, Wired Cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
  • Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. 

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-LM1

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.$149,800 - $206,100 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About usHumana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.