• Job Description

  Req#: R-322874

  Become a part of our caring community and help us put health first
  

  HQRI is an organization that is responsible for improving health outcomes and advancing the care experience of our members and provider partners through integrated risk adjustment (RA) and quality (Stars) solutions that leverage data and technology to empower members, providers, and Humana. HQRI Health Quality and Stars (HQS) is committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS).

  The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings, health condition management, health outcomes, patient experience, and plan operations. Humana has led national competitors for the past five years in the percentage of members in plans rated 4 star or higher, which is a testament to the caring, curious, and committed nature of this highly talented team.

  The Stars Risk, Compliance, and Communications Lead advises Stars leaders on the current regulatory and risk landscape and develops effective strategies for management. This role partners with Stars leaders to ensure compliance and risk management strategies related to the Stars program are in place and tracks and reports progress on these components of the program. This role operates independently, works cross-functionally, exercises independent judgment, and uses in-depth analysis of situations or data to determine the best course of action on complex issues. This role will support overall portfolio management of the Stars organization through research, critical thinking, advisement, decision-making, reporting, and communication.

  Key responsibilities include:

  • Review, determine applicability, and communicate new and proposed regulations for impact across Stars
  • Facilitate public comment period review for the Stars organization to prepare professional written responses for Stars-related proposals, and review, summarize, and present competitor comments and positions
  • Ensure implementation strategies for regulatory changes are adequate and completed, advising and providing consultation as needed
  • Lead annual plan preview and final Star Ratings release processes and own the communication plan for results of each phase
  • Maintain data supporting risk and compliance reporting
  • Own Stars risk management by conducting risk assessments and developing risk management plans for risks across the Stars organization, including support of third party risk management through consultation during due diligence for initiatives and vendor partnerships, and advising and tracking incidents through remediation
  • Own communications as needed, including senior leader reporting and Stars governance meetings
  • Drive process maturity and own the relationship with the HQRI Process Team to support process assessment, documentation, and improvement

  
  Use your skills to make an impact
  

  Required Qualifications

  • Bachelor's degree
  • 5 years compliance, risk management, and/or regulatory advocacy experience
  • 5 or more years of cross-functional project leadership experience, to include leading teams through full process implementation
  • Ability to read and research regulations
  • Excellent technical writing, facilitation, and other communication, both oral and written
  • Comfortable working with and analyzing data
  • Proficient in use of Microsoft Office products (Word, Excel, PowerPoint)
  • Strong relationship building skills and executive poise

  Preferred Qualifications

  • Experience with PowerBI
  • Knowledge of the Stars program
  • Familiarity with CMS regulations
  • Knowledge and experience in health care/managed care regulatory environment
  • Six Sigma Certification
  • Strong analytical skills

  Work-At-Home Requirements

  To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  • Satellite, cellular and microwave connection can be used only if approved by leadership
  • Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

  Additional Information - How we Value You

  • Benefits starting day 1 of employment
  • Competitive 401k match
  • Generous Paid Time Off accrual
  • Tuition Reimbursement
  • Parent Leave
  • Go365 perks for well-being

  Scheduled Weekly Hours

  40

  Pay Range

  The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

  
  

  $112,400 - $154,900 per year

  
  

  This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

  Description of Benefits

  Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

  
  About us
  

  Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

  
  Equal Opportunity Employer

  It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

• About the company

  Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs

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