Senior Stars & Quality Performance Lead — Remote Provider Relations

Humana; United States; Remote; USD 78,000 - 108,000; Full time

Benefits offered by this job

Bonus eligible

Remote work within region (TX/OK/AR)

40-hour work week

Travel up to 25%

Job summary

Humana is seeking a Senior Network Performance Professional to enhance provider performance and STARs ratings across our network. You will collaborate with physician groups to define goals, educate on HEDIS and patient experience, and implement action plans to improve outcomes.

The role emphasizes strategic partnership and data-driven improvement. The position offers remote work within the Texas, Oklahoma, or Arkansas region, with travel up to 25% and a start date planned for January 4, 2027.

Qualifications

• Bachelor's Degree required.
• 2+ years of experience with Medicare and/or managed care.
• Working knowledge of NCQA and CMS Stars Rating System (HEDIS, PQA, CAHPS/HOS).
• Understanding of clinical utilization and levers to improve performance.
• Understanding of interoperability.
• Understanding of Consumer/Patient Experience.
• Experience building relationships with physician groups and influencing execution of strategy.
• Experience with focus on process and quality improvement.
• Able to work 8-5 pm Central Time.
• Willingness to travel at least 25% within Texas, Arkansas, or Oklahoma.

Responsibilities

• Define and advance provider goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies.
• Serve as an expert on the Stars/Quality program and educate physician groups on HEDIS, patient safety, and patient experience.
• Develop tailored action plans and communicate insights to improve performance reward programs.
• Resolve provider abrasion issues and maintain collaborative relationships with Humana’s providers.
• Collaborate with internal teams to track market performance and align with organizational goals.
• Monitor and analyze provider performance data to identify areas for improvement and implement strategies.
• Educate providers on Humana resources and self-serve tools; liaise with internal teams to ensure access to resources.
• Educate provider groups on reward programs and target metrics; monitor effectiveness and suggest enhancements.

Skills

Medicare experience

NCQA & CMS Stars

Interoperability

Provider relations

Quality improvement

Patient experience

Travel readiness

8-5 Central Time

Education

Bachelor's Degree

Master's Degree

Job description

Humana is seeking a Senior Network Performance Professional to enhance provider performance and STARs ratings across our network. You will collaborate with physician groups to define goals, educate on HEDIS and patient experience, and implement action plans to improve outcomes.

The role emphasizes strategic partnership and data-driven improvement. The position offers remote work within the Texas, Oklahoma, or Arkansas region, with travel up to 25% and a start date planned for January 4, 2027.