Become a part of our caring community and help us put health first

The Quality Improvement Professional partners and or aligns with Stars leadership to identify and set quality goals to maximize quality outcomes. They must be comfortable functioning within a team setting especially as it relates to organizational guidelines, defined parameters, and meeting quality targets while on the other hand having some latitude to prioritize efforts, having the ability to work under minimal direction/independently.

Responsibilities

• Incumbent will have an interest and practical experience working with clinical quality measures in particular medication adherence and HEDIS.

• 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 actionable 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.

• Using critical thinking skills, QIP 1 leads efforts to identify opportunities for improvement, workflow deficiencies and barriers.

• Provides support to provider/practice specific needs thus assisting in driving the effective implementation of the quality improvement strategy.

• Manage workloads, having the ability to meet time-sensitive deadlines 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).

• The Incumbent must have excellent interpersonal skills as well as the ability to develop working relationships and partnerships. Must be a “people person” since the role requires seamless teamwork to achieve targets/meet goals.

• 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 eye screenings, bone mineral density, mobile mammogram etc.

• This role would be responsible for supporting both staffed and IPA clinics- Staffed CenterWell Clinics 70% of time and IPA clinics in the Tidewater/Peninsula VA area 30% of the time.

**Incumbent must be located in Virginia

Use your skills to make an impact

Required Qualifications:

• Understanding of healthcare quality measures STARS (HEDIS, Patient Experience (CAHPS/HOS) and Patient Experience in particular knowledge of the measure technical specifications etc.

• Minimum of 2 years' experience working with CMS STARs quality measures.

• Prior experience in a fast-paced health care setting direct hands-on patient care, front office or provider relations field.

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

• Ability to work independently but within team guidelines and standardized workflow.

• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint and excellent communication and presentation skills

Preferred Qualifications:

• Bachelor’s or Associate 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 after 5PM meeting.

• Work-at-home and visits to various medical centers and or IPA offices on a quarterly basis

• Occasional Travel to Tidewater/Peninsula VA area to CenterWell and IPA clinics Mileage. Reimbursement will be provided.

• Must be located in Virginia

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

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.

$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 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 us

About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.