Stars Program Delivery Lead – HEDIS Controlling Blood Pressure

Humana; Garden City (ID); Remote; USD 115,000 - 159,000; Full time

Job summary

A leading healthcare organization is seeking a qualified applicant for a remote position focused on HEDIS Controlling Blood Pressure. This role involves defining improvement strategies and ensuring operational excellence. The ideal candidate will have at least 7 years of experience in program delivery and strong data analysis skills. The remuneration for this full-time role is competitive, with a pay range of $115,200 to $158,400 per year.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Short-term and long-term disability

Life insurance

Qualifications

• 7 years of previous innovation, program delivery and/or strategy experience.
• Proven skills in analyzing data trends and identifying performance improvement opportunities.
• HEDIS experience is required.

Responsibilities

• Define improvement objectives focused on clinical gap closure.
• Conduct audits of data collection processes.
• Support strategic and analytical functions with insights.

Skills

Data analysis

Communication skills

Attention to detail

Program delivery

Collaboration

Education

Bachelor’s Degree in Business Administration or related field

Tools

Microsoft Office (Word, Excel, PowerPoint)

Job description

Overview

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

Health Quality and Stars (HQS) is an organization that is responsible for improving health outcomes and advancing the care experience of our members and provider partners through quality solutions. 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.

Location: Remote or if near Louisville hybrid

Responsibilities

The Lead for HEDIS Controlling Blood Pressure is responsible for the advancement of the initiative improvement strategy, operational execution and performance oversight in effort to achieve high HEDIS condition management Stars performance targets. This individual will define improvement objectives focused on clinical gap closure, health outcomes and improved member experience.

• Accountability for performance and operational excellence of comprehensive programs to improve Star ratings
• Partner with multiple analytics teams to develop, prioritize, deliver, and measure solutions
• Proactively engage the right stakeholders to anticipate headwinds and identify gaps, looking ahead to anticipate pivots and action needed

Provide insights and identify new opportunities for improvement through data analysis of variable factors to determine course of action:

• Ability to make recommendations based on reporting and monitoring by contract, region, provider and aggregate performance, identifying where things are going well and why, as well as where things need to improve and how
• Cross-collaboration with performance management team to interpret and deliver key recommendations to achieve Stars goals

Conduct audits of all data collection and processes to ensure operational excellence across initiatives:

• Create standard operating procedures, document data collection, and establish processes for audit and quality control
• Identify gaps and new opportunities to improve performance

Support key functions with strategic and analytical thinking:

• Requires a general understanding of Stars operations and ability to effectively communicate the Stars story
• Knowledge of the technical specifications and codes within attributed value sets
• Detail oriented and willing to learn the more minute parts of HEDIS measures and gap closure processes with limited guidance and direction
• Use problem solving skills to resolve issues and make decisions in a fast pace, complex, ever-changing environment
• Understand campaign development to provide insights for new concepts, technologies or processes
• Experience with market needs to provide insights to improve performance in key contracts and regions
• Understanding of or experience with clinical setting to advance provider first strategies, influence member interventions and identify new opportunities to impact

Required Qualifications

• Bachelor’s Degree in Business Administration, Health Administration or a related field
• 7 years of previous innovation, program delivery and/ or strategy experience
• Proven skills in analyzing data trends and identifying performance improvement opportunities
• HEDIS experience
• Strong attention to detail and focus on customer experience
• Effective communication skills, written and verbal
• Effective facilitator – direct collaborative efforts amongst business, analytics and technology partners
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint, as well as ability to navigate business intelligence tools to review data insights

Preferred Qualifications

• Master’s Degree
• HEDIS Controlling Blood Pressure measure experience
• Medicare Stars experience

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Employees 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 employees with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$115,200 - $158,400 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.

Application Deadline: 10-02-2025

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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.