CMS Programs Quality Strategy Lead

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess 6+ years of Medicare or Medicaid experience, 3+ years of Quality and/or HEDIS experience, and 3+ years of project management experience with mid to large scale projects. Experience with CMMI programs, working with senior leadership, building templates, standard documentation, disseminating knowledge, and facilitating cross-departmental projects is required. Excellent oral and written communication skills and a flexible, dynamic personality suited for a team environment are also necessary. A Bachelor's degree and 3+ years of experience with data extraction and analysis technologies are preferred.

Responsibilities

The CMS Programs Quality Strategy Lead will support Humana's participation in CMS/CMMI initiatives, specifically developing and implementing the Humana MSSP strategy to assume financial risk for Original Medicare beneficiaries. This role involves defining MSSP success, creating a vision for success, and outlining the strategy to achieve it. The lead will partner externally with ACO providers to focus on quality performance and collaborate cross-functionally with internal business areas like clinical, legal, and compliance, fostering partnerships through strong communication skills.

Skills

Medicare

Medicaid

Quality Strategy

HEDIS

Project Management

CMMI

Value-Based Care

Accountable Care Initiatives

Medicare Shared Savings Program (MSSP)

Provider Relationships

Clinical

Legal

Compliance

Communication

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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