Stars Improvement Professional Jobs

R-314737
Description
Humana Healthy Horizons in Florida is seeking a STARS Improvement Professional 2 who will develop, implement, and manage oversight of the company's Medicaid Stars Program. They will direct all quality improvement programs and initiatives. The STARS Improvement Professional 2 will work on assignments that are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
The STARS Improvement Professional 2 partners with leaders and providers to implement actions related to quality improvement. They understand department, segment, organizational strategy, and operating objectives.
Responsibilities

• Follows established guidelines/procedures.
• Educate providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.
• Identifies specific practice needs (e.g. use of most efficient interaction channel) to providing support.
• Coaches assigned providers on gaps in care opportunities through virtual, telephone and/or email.
• Provides resources and educational opportunities to providers and staff.
• Reviews provider and member-specific UM and QI metrics.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction.
• Prepares and compiles HEDIS reports for distribution to providers.

Required Qualifications

• Must reside in the state of Florida.
• Excellent communication skills.
• Prior Medicaid experience.
• Strong attention to detail and focus on process and quality.
• Associate degree in Business, Health Care, or a related field.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint.
• Prior managed care experience.
• Ability to manage multiple competing priorities and meet deadlines.

Work At Home/Remote Requirements

• Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.
• 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.

Preferred Qualifications

• Bilingual Language in both English and Spanish – Language Proficiency Assessment will be performed to test fluency in reading, writing, and speaking in both languages.
• Knowledge of billing/coding.
• Bachelor's Degree in Business, Healthcare, or a related field.
• Understanding of metrics, trends, and the ability to analyze and identify gaps in care.

Additional Information

• Workstyle: This is a Remote position that requires you to live in the state of Florida.
• Travel: Possible occasional travel to team engagement meetings in the state in Florida.
• Workdays and Hours: Monday – Friday; 40-hour work schedule. Leadership will discuss further in interview.

Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40