Stars Quality Improvement Professional

Become a part of 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. You will 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). Your 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 report to the Associate Director, Quality Improvement.
- You will use 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 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.

- Lead efforts to identify opportunities for improvement, workflow deficiencies and barriers.

- Develop and implement strategies to achieve annual Stars goals within market and centers.

- Provide support to provider/practice specific needs thus helping guide the 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 presentations.

- Collaborate with multiple partners to provide support and in some cases help implement workflows developed to improve outcomes for HEDIS, patient safety (such as medication adherence) and patient experience.

- Support quality project events such as eye screenings, bone mineral density, etc.

Use your skills to make an impact

Required Qualifications:

- Experience with healthcare STARS measures (HEDIS, Patient Safety, andPatient Experience (CAHPS/HOS) in particular knowledge of the measure technicalspecifications.

- 2+ years' experience working with CMS Stars measures.

- Prior experience in a healthcare setting direct hands-on patient care, front office orprovider relations field.

- Experienced providing training 1:1 or in a group setting.

- Experience with Microsoft Office Suite.

- Must reside in the Houston area and be willing to travel locally.

Preferred Qualifications:

- Bachelor's Degree.

- Prior LPN/LVN, Lead Medical Assistant or Center Administrator experience.

- Knowledge of Humana's internal policies, procedures, and systems.

Additional Information:

- Work schedule: M-F, 8am - 5pm.

- Occasional meetings can occur after 5pm.

- This is a remote, work-at-home position that requires visits to medical centers and IPA offices.

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 posi