Strategic AVP, Medical Risk & Provider Engagement

Humana Inc; Austin (TX); On-site; USD 246,000 - 344,000; Full time

Benefits offered by this job

Bonus eligible

Work from home

Competitive benefits

Job summary

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

This senior leader will guide clinical risk adjustment education, drive provider engagement, and develop KPIs, reporting, and education for regional leaders. The role focuses on strategic direction for STARS and risk adjustment initiatives, with oversight of education materials and cross-functional collaboration to improve care quality and provider satisfaction.

Qualifications

• MD or DO with advanced clinical degree.
• Experience in clinical leadership roles 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 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 across STARS and Risk Adjustment initiatives to align with objectives and regulatory requirements.
• Increase provider engagement and satisfaction related to risk adjustment and clinical quality programs.
• Oversee Stars self-reporting metrics including clinical oversight and escalation of issues requiring physician leadership.
• Participate in CMS audits related to Stars and risk adjustment activities with clinical input.
• Educate providers on clinical and operational areas to close Stars gaps and improve quality measures.
• Lead a team supporting risk adjustment education with accurate, timely communications.
• Develop and monitor KPIs for Regional Vice Presidents and Health Services Directors to drive continuous improvement.
• Collaborate with operations, clinical, analytics, and compliance teams to drive success.
• Design and deliver education sessions, materials, and resources for internal teams and provider partners.
• Analyze data trends to identify opportunities for process improvements and enhanced provider engagement.

Skills

Provider engagement

Risk adjustment

Clinical leadership

KPI development

Relationship building

Healthcare analytics

Education

MD/DO

Job description

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

This senior leader will guide clinical risk adjustment education, drive provider engagement, and develop KPIs, reporting, and education for regional leaders. The role focuses on strategic direction for STARS and risk adjustment initiatives, with oversight of education materials and cross-functional collaboration to improve care quality and provider satisfaction.