Remote AVP, Stars Risk Adjustment & Provider Engagement

Humana Inc; Dover (DE); On-site; USD 246,000 - 344,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking an Associate Vice President to lead Medical Risk Adjustment and Provider Engagement.

The role directs clinical strategy, provider education, and KPI reporting for regional leaders, driving Stars and risk adjustment initiatives with physician partners. The position requires an advanced clinical degree and proven leadership in managed care, with strong abilities in data interpretation, performance improvement, and cross-functional collaboration.

Qualifications

• MD or DO required with advanced clinical degree.
• Proven clinical leadership experience in managed care or risk adjustment.
• Experience in Stars risk adjustment and provider engagement.
• Ability to lead high-performing teams and build relationships with providers.
• Experience developing KPIs, reporting, and education programs for health leaders.

Responsibilities

• Provide clinical guidance and SME across all STARS and risk adjustment initiatives to align with objectives and regulatory requirements.
• Demonstrate responsiveness to providers to increase engagement and satisfaction.
• Oversee medical director duties for Stars self-reporting metrics and escalate issues.
• Participate in CMS audits related to Stars and risk adjustment activities.
• Deliver targeted provider education on clinical and operational areas to close Stars gaps.
• Lead a team to support risk adjustment education and communications.
• Develop, implement and monitor KPIs for Regional VP and Health Services Directors.
• Collaborate with operations, analytics, and compliance to drive success.
• Design and deliver education sessions, materials, and resources for internal teams and partners.
• Analyze data to identify opportunities for process improvements and engagement strategies.
• Ensure compliance with regulations, policies, and quality standards.
• Serve as physician signatory for provider disclosure letters when new diagnoses are added to claims.
• Assist with provider reporting, education, and feedback to improve Stars performance.

Skills

Clinical leadership

Risk adjustment

Provider engagement

KPIs & reporting

Education program development

Education

MD/DO

Tools

Data interpretation

Job description

Humana Inc. is seeking an Associate Vice President to lead Medical Risk Adjustment and Provider Engagement.

The role directs clinical strategy, provider education, and KPI reporting for regional leaders, driving Stars and risk adjustment initiatives with physician partners. The position requires an advanced clinical degree and proven leadership in managed care, with strong abilities in data interpretation, performance improvement, and cross-functional collaboration.