Stars Program Delivery Lead – HEDIS Controlling Blood Pressure

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

Healthcare, InsuranceIndustries

Requirements

Candidates must possess a Bachelor's Degree in Business Administration, Health Administration, or a related field. They should have 7 years of experience in innovation, program delivery, or strategy, with proven skills in data trend analysis and identifying performance improvement opportunities. HEDIS experience, strong attention to detail, customer experience focus, effective communication skills (written and verbal), and proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) are also required. Familiarity with business intelligence tools for data review is necessary.

Responsibilities

The Stars Program Delivery Lead will be responsible for advancing the initiative improvement strategy, operational execution, and performance oversight for HEDIS Controlling Blood Pressure to achieve high Stars performance targets. This includes defining improvement objectives for clinical gap closure, health outcomes, and member experience. Key duties involve applying in-depth knowledge of HEDIS condition management measures to develop and implement solutions, partnering with analytics teams, proactively engaging stakeholders, analyzing data to identify opportunities and recommend actions, and conducting audits of data collection and processes to ensure operational excellence. The role also involves supporting key functions with strategic and analytical thinking, understanding campaign development, and leveraging market and clinical insights to improve performance.

Skills

HEDIS

Stars Program

Quality Improvement

Data Analysis

Stakeholder Engagement

Performance Oversight

Clinical Gap Closure

Health Outcomes

Member Experience

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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