Associate Director, Clinical & Quality Provider Engagement - Humana
Tallahassee, FL
About the Job
Become a part of our caring community and help us put health first
The Associate Director, Stars Improvement, Clinical is responsible for the development, implementation, and management oversight of the company's Medicare/Medicaid Stars Program. The Associate Director, Stars Improvement, Clinical requires a solid understanding of how organization capabilities interrelate across department(s).
The Associate Director, Stars Improvement, Clinical work focuses on areas of clinical emphasis. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s) and could lead multiple managers or highly specialized professional associates.
Responsibilities
+ Develop and implement strategies for clinical provider engagement statewide based on HEDIS/Quality performance measures and clinical metrics for PCPs and specialists
+ Oversight of clinical provider engagement team responsible for supporting primary care physicians and OB/GYN providers statewide on HEDIS education, clinical metrics performance, and quality performance improvement initiatives.
+ Collaboration with members of the leadership team in developing performance improvement initiatives and workforce development to maintain and/or improve performance to achieve defined performance thresholds
+ Align and maintain collaborative relationships through interfacing with external stakeholders (i.e. Humana contracted providers and partners, external vendors).
+ Support the development of provider facing materials, resources and trainings to support improvement efforts.
Use your skills to make an impact
Required Qualifications
+ An active Florida license, free of disciplinary actions, is required for Registered Nurses, Advanced Practice Registered Nurses, Physicians, and Physician Assistants.
+ Minimum Educational Requirement: Bachelor's degree in nursing, public health, health administration, health policy, or business.
+ Minimum three, (3), years of experience in the clinical setting
+ Minimum three, (3), years of experience in Quality Improvement/Quality Assurance in the healthcare field.
+ Minimum three, (3), years of leadership experience
+ Previous experience working with providers and provider relations
+ Demonstrated skills in quality improvement concepts, health care data analysis, data mining methods
+ Excellent communication skills and experience in cross-functional collaboration in matrixed organizations.
Preferred Qualifications
+ Master's degree in nursing, public health, health administration, health policy or business.
+ Certified Professional in Health Care Quality (CPHQ) by the National Association of HealthCare Quality (NAHQ)
+ Certified Professional Coder (CPC) certification
+ Understanding of value-based payment models that reward quality improvement.
Additional Information
Workstyle: Remote work at home
Location: Must reside in Florida
Schedule: Monday through Friday 8:30 AM - 5:00 PM Eastern
Travel: 10% travel to market offices as business needs
If you have additional questions regarding this role posting, 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.
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.$112,400 - $154,900 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 us
Humana 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 veteran status. 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Associate Director, Stars Improvement, Clinical is responsible for the development, implementation, and management oversight of the company's Medicare/Medicaid Stars Program. The Associate Director, Stars Improvement, Clinical requires a solid understanding of how organization capabilities interrelate across department(s).
The Associate Director, Stars Improvement, Clinical work focuses on areas of clinical emphasis. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s) and could lead multiple managers or highly specialized professional associates.
Responsibilities
+ Develop and implement strategies for clinical provider engagement statewide based on HEDIS/Quality performance measures and clinical metrics for PCPs and specialists
+ Oversight of clinical provider engagement team responsible for supporting primary care physicians and OB/GYN providers statewide on HEDIS education, clinical metrics performance, and quality performance improvement initiatives.
+ Collaboration with members of the leadership team in developing performance improvement initiatives and workforce development to maintain and/or improve performance to achieve defined performance thresholds
+ Align and maintain collaborative relationships through interfacing with external stakeholders (i.e. Humana contracted providers and partners, external vendors).
+ Support the development of provider facing materials, resources and trainings to support improvement efforts.
Use your skills to make an impact
Required Qualifications
+ An active Florida license, free of disciplinary actions, is required for Registered Nurses, Advanced Practice Registered Nurses, Physicians, and Physician Assistants.
+ Minimum Educational Requirement: Bachelor's degree in nursing, public health, health administration, health policy, or business.
+ Minimum three, (3), years of experience in the clinical setting
+ Minimum three, (3), years of experience in Quality Improvement/Quality Assurance in the healthcare field.
+ Minimum three, (3), years of leadership experience
+ Previous experience working with providers and provider relations
+ Demonstrated skills in quality improvement concepts, health care data analysis, data mining methods
+ Excellent communication skills and experience in cross-functional collaboration in matrixed organizations.
Preferred Qualifications
+ Master's degree in nursing, public health, health administration, health policy or business.
+ Certified Professional in Health Care Quality (CPHQ) by the National Association of HealthCare Quality (NAHQ)
+ Certified Professional Coder (CPC) certification
+ Understanding of value-based payment models that reward quality improvement.
Additional Information
Workstyle: Remote work at home
Location: Must reside in Florida
Schedule: Monday through Friday 8:30 AM - 5:00 PM Eastern
Travel: 10% travel to market offices as business needs
If you have additional questions regarding this role posting, 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.
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.$112,400 - $154,900 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 us
Humana 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 veteran status. 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana
