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The Director, Quality and Risk Adjustment, a member of the Regional Leadership team reporting to the Regional Vice President of Provider Performance, is responsible for the successful execution of Stars and Risk Adjustment strategy and performance within a designated region. Identifies regional nuances that have provider impact combined with an operational mindset. This opportunity requires the ability to effectively partner across the Region and with the Corporate Stars and MRA organizations, a highly inclusive leadership style, and the ability to lead and develop a team with diverse experience. The Director, Quality and Risk Adjustment implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

• Responsible for 3 direct and 30 indirect reports including Manager, Stars Improvement and Stars Improvement Professionals
• Responsible for developing and implementing strategies to increase interoperability of data working with established EMR systems, and vendor solutions
• Works closely with the Provider Engagement team to provide support for Quality and Risk Adjustment functions as a subject matter expert
• Partners w/ Director Provider Engagement to influence provider relationships and performance outcomes
• Works with Corporate Risk Adjustment, Quality, and Interoperability teams
• Implements strategic plans, drives goals and objectives, and improves performance

Desired Skillset:

• Experience aligning goals to strategy, organize resources, prioritize initiatives
• Collaborative. Ability to execute within matrix-style organizational structure.
• Demonstrated ability to efficiently operate within tight timelines and to pivot as business needs dictate
Ability to lead through influence

Use your skills to make an impact

Required Qualifications:

• Bachelors Degree
• Prior experience in market strategy and decisions based on Stars and Risk Adjustment
• 3+ years of experience directly leading and developing teams
• Provider engagement/Provider performance experience
• Prior experience in analyzing and interpreting data trends with the ability to understand and effectively anticipate business impact

Preferred Qualifications:

• 3+ years of Stars and/or Risk Adjustment programs experience
• Knowledge of Stars and CMS quality measures
• Knowledge of CMS Medicare Risk Adjustment model
• Advanced degree
• Strong financial acumen
• Previous experience in a health solutions organization

Additional Information

Location: NY, PA, MD, NJ, KY preferred

Work at Home/Remote Requirements

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 to support Humana applications, per associate.
  • Wireless, Wired Cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
  • Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. 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

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

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Scheduled Weekly Hours

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Description of Benefits

About us

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.