Senior Stars Improvement Clinical Professional - Prime West - Nevada

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Job Information
Humana
Senior Stars Improvement, Clinical Professional - Prime West - Nevada
in
Las Vegas
Nevada
Description
The Senior Stars Improvement, Clinical Professional responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Senior Stars Improvement, Clinical Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Responsibilities
The Senior Stars Improvement, Clinical Professional This work focuses on areas of clinical emphasis. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, andwork is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Identifies specific provider practice needs (e.g. use of most efficient interaction channel) to providing support
Reviews claims / medical records and identify needed improvements that impact HEDIS or Star measures, coding or effective clinical utilization
Engages with Providers in the field to educate on Star measures, coding and clinical strategies to improve patient outcomes
Assists practices with member outreach to encourage preventive screenings and tests
Educates and collaborates with the Provider Engagement Professionals to ensure appropriate provider communication and reporting
Effectively coaches provider office staff on best means to communicate with Senior members that may have hearing, vision, and physical challenges
In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:
Medical Benefits
Dental Benefits
Vision Benefits
Health Savings Accounts
Flex Spending Accounts
Life Insurance
401(k)
PTO including 7 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
And more
Required Qualifications
5 years of clinical experience
Prior Medicare/Medicaid experience
Previous experience working in a Primary Care provider office setting
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
Strong attention to detail with a focus on process and quality
Excellent communication skills both verbal and written
Ability to operate under tight deadlines
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Ability to travel up to 50% locally
Preferred Qualifications
Associate's or Bachelor's Degree in Business, Finance, Health Care or a related field
Understanding of CMS Stars, performance measures, HEDIS knowledge and experience
Progressive experience in the health solutions industry
Prior managed care experience
Understanding of metrics, trends and the ability to analyze and identify gaps in care
Proven organizational and prioritization skills and ability to collaborate with multiple departments
Background working in quality improvements
Additional Information
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination or commit to testing protocols
*OR  *
Provide proof of applicable exemption including any required supporting documentation
​​Medical, religious, state and remote-only work exemptions are available.
Interview Format:
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire interview. In this interview, you will read to a set of interview questions and you will enter/text responses to each question. You should anticipate this interview to take about 10 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Alert:
Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from **** with instructions to add the information into the application at Humana's secure website.
Scheduled Weekly Hours
40

Company info

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