Stars Program Delivery Senior Professional – HEDIS Condition Management

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor's Degree and have 5 years of experience in innovation, program delivery, or project management. Proven skills in analyzing data trends and identifying performance improvement opportunities are required, along with the ability to present program delivery milestones and performance. Strong attention to detail, a focus on customer experience, and the ability to articulate ideas effectively in written and oral forms are essential. Comprehensive knowledge of Microsoft Office applications (Word, Excel, PowerPoint) and the ability to navigate business intelligence tools are also necessary. Preferred qualifications include a Master's Degree and experience with HEDIS or Medicare Stars.

Responsibilities

The Senior Professional will accelerate measure improvement efforts to enhance HEDIS performance by strategically identifying, developing, and implementing programs that influence members and market leadership towards improved quality metrics. This role involves working closely with the condition management team, Stars Operations, and other business partners to understand goals and align initiatives with long-term strategy. Responsibilities include leading initiatives from ideation through performance monitoring and identifying opportunities for improvement, partnering with analytics and IT teams to support data and reporting tools, and deriving actionable insights. The individual will influence enterprise teams to deliver and prioritize work impacting goals, provide education, and ensure performance oversight. They will also make decisions on moderately complex to complex issues regarding the technical approach for project components.

Skills

HEDIS

Condition Management

Quality Improvement

Strategic Planning

Data Analysis

Program Management

Cross-functional Collaboration

Performance Monitoring

Reporting Tools

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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