Stars - Quality Improvement Professional

About the Role

As a Stars Quality Improvement Professional, you will support clinicians and staff, working collaboratively with clinical and operations teams, including center administrators. Your role will involve providing support, making recommendations, and helping implement quality improvement best practice programs designed to improve CMS Star measures (HEDIS), patient safety, and patient experience (CAHPS-HOS). You may also cover PCO staffed providers and PCO Independent Network providers/practices, functioning in a similar capacity to support staffed centers.

The ideal candidate will have an interest and practical experience working with clinical Star measures, particularly medication adherence and HEDIS. You will need to work in and around our Las Vegas clinics 4 out of 5 days.

Responsibilities

• Utilize approved avenues to outreach to patients with medication reminders.
• Conduct medical record review, retrieval, and submissions to health plans to support HEDIS gap closure.
• Distribute time-sensitive and relevant data to promote action by clinical teams and operations to address opportunities and close gaps (moderate-to-advanced Excel skills required).
• 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 strategic action plans to achieve annual Stars goals within the market and/or centers.
• Provide support to provider/practice-specific needs, assisting in driving the effective implementation of the quality improvement strategy.
• Manage workloads such as the distribution of medication adherence reports to primary care providers (PCPs).
• Train and educate teams on CMS Star measures, either one-on-one or in group settings (clinicians, medical assistants, practice administrators, front office).
• Present Stars performance information during meetings, either one-on-one or in wider settings, and create PowerPoint presentations.
• Collaborate 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 assist with the execution of workflows developed to improve outcomes for HEDIS, patient safety (such as medication adherence), and patient experience.
• Support quality initiatives events such as eye screenings and bone mineral density tests.

Requirements

• Strong understanding of healthcare STARS measures (HEDIS, Patient Safety, and Patient Experience (CAHPS/HOS)), with particular knowledge of the measure technical specifications.
• 2+ years of experience working with CMS Stars measures.
• Prior experience in a healthcare setting with direct hands-on patient care, front office, or provider relations.
• Experience providing training one-on-one or in a group setting.
• Comprehensive knowledge of Microsoft Office (Word, Excel, and PowerPoint) and excellent communication and presentation skills.
• Willingness to travel locally to our CenterWell Nevada market.
• Must reside in the Las Vegas area.

Preferred Qualifications

• Bachelor’s Degree.
• Prior LPN/LVN, Lead Medical Assistant, or Center Administrator experience.
• Knowledge of Humana’s internal policies, procedures, and systems.

Schedule

• Monday to Friday, 8 AM – 5 PM.
• Occasional meetings after 5 PM.
• Hybrid schedule: work-at-home and visits to medical centers and/or IPA offices.

To ensure effective remote work, your self-provided internet service must meet the following criteria: at minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps; wireless, wired cable, or DSL connection is suggested. Satellite, cellular, and microwave connections may be used only if approved by leadership.

Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information. Occasional travel to Humana’s offices for training or meetings may be required.

Pay

The pay range for this full-time (40 hours per week) position is $53,700 - $72,600 per year. The range may be higher or lower based on geographic location, and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, and certifications.

Benefits

Humana offers competitive benefits designed to support whole-person well-being, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.
• Additional opportunities for personal and professional growth.

About CenterWell Senior Primary Care

CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, and minor injury treatment. 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—comprising physicians, nurses, behavioral health specialists, and more—spend up to 50% more time with patients, delivering compassionate, personalized care that leads to better health outcomes. We address not only physical health but also other factors that influence patient well-being.

CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that prioritize patients. As the largest provider of senior-focused primary care, a leading provider of home healthcare, and a prominent integrated home delivery, specialty, hospice, and retail pharmacy provider, CenterWell emphasizes whole health and addresses the physical, emotional, and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more at CenterWell.com.