Stars Improvement Professional

Job Description

The STARS Improvement Professional 2 partners with leaders and providers to implement actions related to quality improvement. They understand department, segment, organizational strategy, and operating objectives.

Responsibilities:

• Reviews provider and member-specific UM and QI metrics.
• Coaches assigned providers on gaps in care opportunities through virtual, telephone and/or email.
• Provides resources and educational opportunities to providers and staff.
• Identifies specific practice needs (e.g. use of most efficient interaction channel) to providing support.
• Educate providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.
• Prepares and compiles HEDIS reports for distribution to providers.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction.
• Follows established guidelines/procedures.

Required Qualifications

• Associate degree in Business, Health Care, or a related field.
• Prior Medicaid experience.
• Prior managed care experience.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint.
• Strong attention to detail and focus on process and quality.
• Excellent communication skills.
• Ability to manage multiple competing priorities and meet deadlines.

Work at Home/Remote Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• 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 and computer 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.

Preferred Qualifications

• Bachelor's Degree in Business, Healthcare, or a related field.
• Knowledge of billing/coding.
• Understanding of metrics, trends, and the ability to analyze and identify gaps in care.
• Bilingual Language in both English and Spanish – Language Proficiency Assessment will be performed to test fluency in reading, writing, and speaking in both languages.

Additional Information

• Workstyle: Remote, US.
• Workdays and Hours: Monday – Friday; 40-hour work schedule. Leadership will discuss further in interview.
• Travel: Possible occasional travel to team engagement meetings in the state in Florida.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Social Security Task

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

#LI-Remote