[Remote] Program Delivery Lead: Stars Quality Provider Optimization HOS at Humana

San Antonio, Texas, United States

Humana Logo
Not SpecifiedCompensation
Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor's degree in business administration, healthcare administration, healthcare management, or public health, or a related field. A minimum of 7 years of direct experience in healthcare, patient experience, provider engagement, and/or Medicare Stars Quality is required, along with provider experience or a previous provider-facing role. Demonstrated success in relationship management, performance improvement, education and support, problem-solving, and conflict resolution is essential. Excellent communication, leadership, influence, and stakeholder management skills, as well as proficiency with Microsoft Office, are also required.

Responsibilities

The Program Delivery Lead will provide guidance, support, and relationship management to key provider partners regarding HOS measures and patient experience. This role involves collaborating with network and provider rewards teams to develop and execute strategies for HOS score improvement, and translating stakeholder requirements into actionable provider strategies. Responsibilities include developing a provider engagement strategy for performance improvement in healthcare outcomes and patient experience, leading tactic execution, collaborating on engagement strategy, providing status updates to leadership, and reporting on program results and their impact on the Medicare Health Outcomes Survey and patient experience. The lead will advise executives on functional strategies for the Medicare Stars program, develop and deepen partnerships with provider-facing teams, establish forums for effective communication, drive accountability for provider-facing core metrics, innovate HOS elements of the patient experience program, develop and maintain processes for evaluating network accessibility, evaluate and define HOS incentives, refine and implement provider support materials, implement regular performance reporting, and deliver training on change management strategies, HOS program resources, incentives, and performance expectations. Additionally, the role involves engaging provider-facing teams on high-priority providers, driving performance accountability, and developing and implementing new mental and physical health initiatives.

Skills

Provider Engagement
Performance Improvement
Healthcare Outcomes
Patient Experience
Medicare Stars Program
Strategy Development
Cross-functional Collaboration
Relationship Management
Data Analysis
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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