AVP, Stars & Risk Adjustment: Clinical Strategy Leader

Humana Inc; Helena (MT); On-site; USD 246,000 - 344,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Disability and life insurance

Job summary

Humana Inc. is seeking an Associate Vice President of Medical Risk Adjustment and Provider Engagement to lead clinical risk adjustment initiatives and drive provider engagement.

The role oversees education, KPIs, and cross-functional collaboration to improve Stars performance and provider satisfaction. The position is remote, with travel as needed, and involves leading a team, developing strategic plans, and presenting to regional leadership.

Qualifications

• Advanced clinical degree (MD, DO) required.
• Experience leading clinical or quality-improvement teams.
• Experience in risk adjustment or Stars.
• Proven ability to develop high-performing teams.
• Strong communication and provider engagement experience.
• Experience creating and monitoring KPIs, reporting, and education programs.
• Ability to interpret clinical and quality data for performance improvement.

Responsibilities

• Provide clinical guidance across STARS and Risk Adjustment initiatives.
• Increase provider engagement and satisfaction related to risk adjustment.
• Oversee Stars self-reporting metrics and medical oversight.
• Participate in CMS audits related to Stars and risk adjustment.
• Provide targeted provider education to close Stars gaps.
• Lead a team supporting risk adjustment education.
• Develop and monitor KPIs for regional leaders.
• Collaborate with operations, analytics, compliance teams.
• Oversee education sessions, materials, resources for internal and provider partners.
• Analyze data to identify process improvements and engagement opportunities.
• Ensure compliance with regulations and internal policies.
• Serve as physician signatory for provider disclosure letters when claims modified.
• Assist with provider reporting and feedback loops.

Skills

Leadership

Provider engagement

KPIs & reporting

Communication

Strategic direction

Team development

Clinical leadership

Education

MD/DO or Advanced clinical degree

Job description

Humana Inc. is seeking an Associate Vice President of Medical Risk Adjustment and Provider Engagement to lead clinical risk adjustment initiatives and drive provider engagement.

The role oversees education, KPIs, and cross-functional collaboration to improve Stars performance and provider satisfaction. The position is remote, with travel as needed, and involves leading a team, developing strategic plans, and presenting to regional leadership.