Description Humana Edge: Who We AreImagine using your workday to make a meaningful difference in peoples lives. Envision working in an environment where you are not only encouraged to create a positive change but also given the tools to make that change happen.Welcome to Humana Edge! Our mission is to transform the experience that we provide for seniors working to meet their social, emotional, and medical needs. As an Edge associate you will guide members through their healthcare journey, ensuring they receive the guidance and support they need so they can focus on fulfilling their lifes ambitions and goals. At the Edge, whole person health is about discovery, connections, and community. This is a unique opportunity to help shape the technology-enabled services we will build together to deliver on our shared vision. We are looking for individuals who are:Passionate about transforming our care system for those who need it most Driven to do well by doing whats rightWilling to thoughtfully disrupt the status-quo and excited to work in a rapidly evolving start-up environment Responsibilities The STARS Improvement Clinician is responsible for the development, implementation, and management oversight of the EDGEs STARS Program, with focus on areas of clinical emphasis. The role requires frequent cross departmental collaborations and conducting briefings and area meetings; and maintains frequent contact with other managers across the department. The role is supporting the ownership of executing and managing quality improvement activities for HEDIS measures and hybrid data collection, CAHPS and HOS improvement, Pharmacy / Part D, general STARS program education and related activities, as well as other activities as assigned. The successful candidate will report directly to the Care team/Care Delivery Quality and Compliance lea and will be responsible for: + Creating alignment between care team population health activities and STARS/HEDIS Strategy for the EDGE + Development and coordination of clinical programs with the interdisciplinary team based on analytics to improve member outcomes. + Monitoring, tracking and trending analytical data to identify opportunities/interventions to improve member outcomes + Assisting in the training and implementation of clinical programs and/or modifications as needed to improve member experience as it relates to STARS/HEDIS initiatives + Monitoring clinical programs for efficiencies and effectiveness Required Qualifications + Valid clinical license + 3+ years of clinical experience + Strong knowledge of any and/or all of the following: HEDIS, STARS, Medicare, Quality + Understanding of metrics, trends, and the ability to identify gaps in care + Strong organizational and prioritization skills with ability to collaborate with multiple departments + Detail orientated and comfortable working with tight deadlines in a fast-paced environment + Ability to work independently under general instructions, self-directed and motivated + Excellent written and oral communication skills + Excellent PC skills (including MS Word, Excel and PowerPoint) Preferred Qualifications + Registered Nurse, Social Work, Clinical Pharmacy or another clinical license + Bachelor's Degree in Business Administration, Health Administration, or a related field + Progressive experience in the health solutions industry + Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus Additional Information As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage SMS Text/Voice Messaging to enhance our hiring and decision-making ability. Montage SMS Text/Voice Messaging 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 Important Information Regarding COVID-19In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation and will adjust service levels as the coronavirus situation evolves. The changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and well-being during the hiring process.#ThriveTogether #WorkAtHome Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. California Residents If you are a California resident and would like to review our California Consumer Privacy Act (CCPA) Policy click here: CA Resident Privacy Policy <>
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