Director, Quality and Risk Adjustment

Director, Quality And Risk Adjustment

Become a part of our caring community and help us put health first. The Director, Quality and Risk Adjustment has regional oversight of the development and implementation of the company Medicare / Medicaid Stars Program. Oversees Stars quality improvement programs and initiatives to increase the plan quality. Has regional oversight of risk adjustment to ensure appropriate implementation of programs and data quality that is submitted to CMS and other governmental agencies. The Director, Quality and Risk Adjustment requires an in-depth understanding of how organization capabilities interrelate across the function or segment. The Director, Quality and Risk Adjustment, a member of the Regional Leadership team reporting to the Regional Vice President of Network 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. The Director, Quality and Risk Adjustment will be responsible for developing relationships with key leaders at provider organizations to help drive overall performance in Humana's contracted programs.

Required Qualifications :

• Bachelor's Degree
• Proven ability to develop and operationalize strategy
• Proficiency in analyzing and interpreting data trends with the ability to understand and effectively anticipate business impact
• Minimum of 5 years of experience in provider performance management within Medicare Advantage programs, including oversight of provider networks, value-based care initiatives, and performance improvement strategies
• Knowledge of Stars and / or Risk Adjustment programs or other related functions
• Ability to influence market strategy and decisions based on Stars and Risk Adjustment considerations
• Demonstrated ability to efficiently operate within tight timelines and to pivot as business needs dictate
• Applies strong financial acumen to support strategic healthcare decisions
• Leads and influences cross-functional teams to achieve organizational goals
• Drives continuous improvement in provider and member experience
• Communicates effectively with diverse stakeholders, both verbally and in writing
• Skilled in Microsoft 365 tools, including Word, Excel, Outlook, and PowerPoint

Preferred Qualifications :

Additional Information :

Location : Nationwide (U.S.); candidates based in Central or Eastern Time Zones strongly preferred due to team collaboration and meeting schedules.

Work-At-Home Requirements :

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 : $165,000 - $226,900 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 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.