Stars Program Delivery Lead – HEDIS Controlling Blood Pressure
HumanaFull Time
Senior (5 to 8 years), Expert & Leadership (9+ years)
Candidates must have 5+ years of experience in HEDIS, quality improvement, or healthcare data analysis, preferably within a health plan, health tech company, or consulting firm. Proven experience in a client-facing or consulting role is required, along with expert-level knowledge of HEDIS technical specifications and the NCQA reporting process. In-depth familiarity with Medicare Advantage STAR ratings and associated quality measures, as well as a strong understanding of health plan operational data including claims processing, clinical data exchange, and member/provider demographics, are essential. Proficiency in SQL and data visualization tools is also necessary.
The Mgr, Strategic Analytics will serve as the primary point of contact for assigned clients, building strong relationships and conducting regular meetings to review performance and discuss strategic initiatives. Responsibilities include providing expert guidance on HEDIS quality measures, NCQA reporting, and STARs methodology, and translating complex data into actionable insights. The role involves analyzing large datasets to identify HEDIS gaps and performance trends, developing dashboards, performing root cause analysis, and collaborating with internal teams on data accuracy and tool development. Additionally, the position requires developing and recommending tailored strategies for HEDIS gap closure, monitoring their effectiveness, and staying current with HEDIS, NCQA, and CMS STARs requirements. Project management for multiple client projects, preparing detailed reports and presentations, and contributing to the development of best practices and scalable processes are also key duties.
Comprehensive pharmacy and healthcare services
CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.