Stars Quality Improvement Specialist - HEDIS (Remote)

Humana Inc; Austin (TX); On-site; USD 59,000 - 80,000; Full time

Job summary

Humana Inc. invites applications for a Stars Quality Improvement Professional to support clinicians and staff and to collaborate with quality teams to improve CMS Star measures, patient safety, and patient experience.

The role emphasizes medication adherence and data-driven improvements within our CenterWell network. You will coordinate with clinical and operations teams, develop strategies, present performance metrics, and occasionally travel to local centers for training and implementation

Qualifications

• Experience with CMS STARS measures (HEDIS, Patient Safety, and Patient Experience) and knowledge of measure specifications.
• 2+ years' experience working with CMS Stars measures.
• Prior experience in a healthcare setting (direct hands-on patient care, front office or provider relations).
• Experience providing training 1:1 or in group settings.
• Experience with Microsoft Office Suite.
• Must reside in the Houston area and be willing to travel locally.

Responsibilities

• Outreach to patients with medication reminders via approved channels.
• Medical record review and submission to health plans to support HEDIS gap closure.
• Distribute data to clinical teams to prompt action and close gaps (Excel proficiency).
• Review HEDIS data/gap reports to identify opportunities for improvement.
• Lead opportunities to improve workflows and address barriers.
• Develop and implement strategies to meet annual Stars goals.
• Support provider/practice needs to implement quality improvement strategies.
• Manage workloads such as distribution of medication adherence reports to PCPs.
• Train teams on CMS Star measures (1:1 or group).
• Present Stars performance data in meetings and create PowerPoint presentations.
• Collaborate with partners to implement workflows that improve HEDIS, patient safety, and patient experience.
• Support quality events such as eye screenings and bone density.

Skills

HEDIS/CAHPS

CMS Stars

Training delivery

Microsoft Office

Healthcare experience

Travel locally

Education

Bachelor's Degree

Job description

Humana Inc. invites applications for a Stars Quality Improvement Professional to support clinicians and staff and to collaborate with quality teams to improve CMS Star measures, patient safety, and patient experience.

The role emphasizes medication adherence and data-driven improvements within our CenterWell network. You will coordinate with clinical and operations teams, develop strategies, present performance metrics, and occasionally travel to local centers for training and implementation