Senior Stars Improvement Clinical Professional - Work at Home ID or UT

Profile

Description

The Senior Stars Improvement, Clinical Professional responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Senior Stars Improvement, Clinical Professional 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, Clinical Professional This work focuses on areas of clinical emphasis. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.


Effectively develop, enhance and maintain provider clinical relationship across product lines
Deliver provider/member-specific metrics (e.g., Star Quality Reports (SQR), Member on a page, Anvita alerts) and coach providers on quality gap closing opportunities for Humana members
Successfully promote practice-patients' participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement
Accurately define gaps in Humana's service relationship with providers and facilitate resolution
Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support
Review medical records and identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture, use SQR to identify information and provide guidance to practice)
Effectively coach provider office staff on best means to communicate with Senior members that may have hearing, vision, physical abilities challenges (i.e. Perfect Service orientation)
This role will work closely with Market/Region MRA, Clinical and Provider Engagement Staff.


Required Qualifications


Desire to consult and influence providers to improve practice processes that enhance care
3-6 years of experience working in a provider office, practice or hospital setting
Strong analytic skills and ability to use data to drive improvement activities
Strong understanding and ability to read medical charts and use EMRs in order to identify evidence of care and improvement opportunities
Strong organizational and prioritization skills with ability to collaborate with multiple departments in a team environment
Detail orientated and comfortable working with tight deadlines in a fast paced environment
Ability to work independently under general instructions, self-directed and motivated
Excellent PC skills (including MS Word, Excel and PowerPoint)
Managed Care experience and understanding of value-based care model
This position will require local travel to provider offices 20%-25% of the time
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10Mx1M


Preferred Qualifications


Strong knowledge of HEDIS/Stars/CMS/Quality
RN or LPN
Previous health plan operations experience
Knowledge of medical coding


Scheduled Weekly Hours

40

Company info

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