Stars Program Delivery Lead - HEDIS

Job Summary

Employment Type: Full time

Become a part of our caring community and help us put health first. The Stars Program Delivery Lead strategically identifies, develops, and implements programs that influence providers, members or market leadership towards value-based relationships and/or improved quality metrics. The Program Delivery Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Location: Remote (If in driving distance to Louisville office, role will be hybrid which is a combination of in office and work at home)

Program Strategy and Implementation

Apply in-depth and broad knowledge of HEDIS measures to develop strategy and implement comprehensive solutions to drive overall Stars performance:

• Accountability for performance and operational excellence of comprehensive programs to improve Star ratings
• Partner with multiple analytics teams to develop, prioritize, deliver, and measure solutions
• Proactively engage the right stakeholders to anticipate headwinds and identify gaps, looking ahead to anticipate pivots and action needed

Data Analysis and Insights

Provide insights and identify new opportunities for improvement through data analysis of variable factors to determine course of action:

• Ability to make recommendations based on reporting and monitoring by contract, region, provider and aggregate performance, identifying where things are going well and why, as well as where things need to improve and how
• Cross-collaboration with performance management team to interpret and deliver key recommendations to achieve Stars goals

Process Audits and Improvement

Conduct audits of all data collection and processes to ensure operational excellence across initiatives:

• Create standard operating procedures, document data collection, and establish processes for audit and quality control
• Identify gaps and new opportunities to improve performance

Strategic Support and Communication

Support key functions with strategic and analytical thinking:

• Requires a general understanding of Stars operations and ability to effectively communicate the Stars story
• Knowledge of the technical specifications and codes within attributed value sets
• Detail oriented and willing to learn the more minute parts of HEDIS measures and gap closure processes with limited guidance and direction
• Use problem solving skills to resolve issues and make decisions in a fast pace, complex, ever-changing environment
• Understand campaign development to provide insights for new concepts, technologies or processes
• Experience with market needs to provide insights to improve performance in key contracts and regions
• Understanding of or experience with clinical setting to advance provider first strategies, influence member interventions and identify new opportunities to impact

Use your skills to make an impact.

Required Qualifications

• Bachelor’s Degree or equivalent work experience
• 8+ years of operations, program management and/or strategy experience
• 2+ Medicare Stars and HEDIS knowledge or experience
• Superb communication skills, written and verbal
• Experience leading special projects and producing metrics, measurements and reports
• Proficiency in interpreting data trends and applying to operations
• Comfortable working independently to accomplish components of a larger program
• Strong organizational and time management skills

Preferred Qualifications

• Master’s degree
• Clinical experience

Additional Information

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their role.