Senior Director, Stars & Risk Adjustment

Humana Inc; Boise (ID); On-site; USD 246,000 - 344,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Job summary

Humana Inc in the United States seeks Associate Vice President, Medical Risk Adjustment and Provider Engagement to provide clinical leadership and strategic direction for STARS and Risk Adjustment initiatives.

This role partners with physicians, physician groups, and market leadership to drive provider engagement, education and measurement of care delivery, developing KPIs, reporting, and education programs to improve clinical quality and program performance.

Qualifications

• Advanced clinical degree (MD, DO) required.
• Demonstrated experience in clinical leadership roles in managed care, risk adjustment, or quality improvement.
• Experience with risk adjustment and Stars programs.

Responsibilities

• Provide clinical guidance across STARS and risk adjustment initiatives to align with regulatory requirements.
• Increase provider engagement and satisfaction related to risk adjustment and quality programs.
• Oversee Stars self-reporting metrics, including clinical oversight and escalation of issues.
• Participate in CMS audits related to Stars and risk adjustment activities.
• Develop and monitor KPIs, reporting, and educational initiatives for leaders.
• Lead a team supporting risk adjustment education and communications.

Skills

Clinical leadership

Provider engagement

Education program design

KPI development

Cross-functional collaboration

Education

MD/DO

Tools

CMS/STARS

Job description

Humana Inc in the United States seeks Associate Vice President, Medical Risk Adjustment and Provider Engagement to provide clinical leadership and strategic direction for STARS and Risk Adjustment initiatives.

This role partners with physicians, physician groups, and market leadership to drive provider engagement, education and measurement of care delivery, developing KPIs, reporting, and education programs to improve clinical quality and program performance.