Stars & Risk Adjustment Strategy Lead

Humana; United States; 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 insurance

Life insurance

Job summary

Humana is seeking an Associate Vice President to lead Medical Risk Adjustment and Provider Engagement, driving STARS initiatives and provider satisfaction across regions. You will oversee risk education, KPI development, and education delivery for Health Services Directors and Regional VPs.

The role requires an MD or DO with proven leadership in risk adjustment, strong communication, and the ability to develop metrics and reporting that improve care quality and compliance.

Qualifications

• Advanced clinical degree (MD, DO) required.
• Demonstrated experience in clinical leadership roles, preferably within managed care, risk adjustment, or quality improvement environments.
• Risk adjustment and Stars experience
• Proven ability to lead and develop high-performing teams.
• Strong communication and relationship-building skills with experience engaging provider organizations.
• Experience developing and monitoring KPIs, reporting, and educational programs for healthcare leaders.
• Proficiency in interpreting clinical and quality data to drive performance improvement.

Responsibilities

• Provide clinical guidance and subject matter expertise across all STARS and Risk Adjustment initiatives to ensure alignment with organizational objectives and regulatory requirements.
• Demonstrate high responsiveness to providers, with the goal of increasing provider engagement and satisfaction related to risk adjustment and clinical quality programs.
• Serve as the overseeing medical director for Stars self-reporting metrics, including clinical oversight, interpretation, and escalation of issues requiring physician leadership.
• Participate in CMS audits related to Stars and risk adjustment activities, complementing technical and operational audit support with physician-level clinical expertise.
• Provide targeted provider education on clinical and operational areas needed to close Stars gaps and improve performance on quality measures.
• Lead and manage a team dedicated to supporting risk adjustment education, ensuring that materials and communications are accurate, timely, and effective.
• Develop, implement, and monitor KPIs for Regional Vice Presidents and Health Services Directors, ensuring that performance metrics, reporting processes, and educational initiatives support continuous improvement in risk adjustment outcomes and provider engagement.
• Collaborate cross-functionally with internal stakeholders, including operations, clinical, analytics, and compliance teams, to drive the success.
• Oversee the design and delivery of education sessions, materials, and resources for both internal teams and provider partners.
• Analyze data and trends to identify opportunities for process improvements and enhanced provider engagement strategies.
• Ensure that all risk adjustment activities are conducted in compliance with applicable regulations, internal policies, and quality standards.
• Serve as the physician signatory for provider disclosure letters related to risk adjustment when Humana modifies a claim with a new diagnosis, ensuring communications are clinically appropriate and compliant.
• Assist with provider reporting, provider education, and feedback loops to support accurate documentation, improved Stars performance, and compliant risk adjustment practices.

Skills

Leadership

Provider engagement

Communication

KPI development

Data interpretation

Education

MD/DO

Job description

Humana is seeking an Associate Vice President to lead Medical Risk Adjustment and Provider Engagement, driving STARS initiatives and provider satisfaction across regions. You will oversee risk education, KPI development, and education delivery for Health Services Directors and Regional VPs.

The role requires an MD or DO with proven leadership in risk adjustment, strong communication, and the ability to develop metrics and reporting that improve care quality and compliance.