Manager Quality Audit CenterWell Stars HEDIS Improvement and Operations

Profile

Description

CenterWell Senior Primary Care, a subsidiary of Humana Inc., is the new brand for a primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, Missouri, Nevada, North Carolina, South Carolina and Texas. CenterWell Senior Primary Care has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary care combined with an excellent patient experience. CenterWell Senior Primary Care has experience in both the treatment and management of most chronic and acute-care conditions. The practices also provide health education and value-added, well-being services at the centers and around their neighborhoods to help both patients and community members improve their health.

At CenterWell Senior Primary Care, we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all.

Responsibilities

The Manager, Quality Audit analyzes and investigates quality issues. The Manager, Quality Audit works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Job Description

The Manager, Quality Audit (Stars HEDIS Improvement and Operations), leads the advancement of initiative improvement strategy, operational execution and performance oversight in effort to maintain CenterWell's strong HEDIS Stars results. The individual will lead the team in defining improvement objectives focused on clinical gap closure, health outcomes and improved member experience.

Role responsibilities :

Have a deep understanding of HEDIS Stars measures

Focus on improvement initiatives directed on delivering improved performance rates and optimal customer experiences

Lead a quality team that spans multiple states and health plan payors

Create collaborative working relationships with partners across the organization in effort to create shared learning agendas and goals

Oversee performance oversight and roadmap toward operational excellence for Stars HEDIS operational areas such as: Test Kit Program operations, Stars Outreach team, and HEDIS process improvement

Must be able to take complex problems and distill into manageable pieces to develop solutions

Responsible for performance monitoring and operational reporting, with regular executive summary roll-up to leadership developing robust reporting informing prioritized opportunities for Quality improvement and experience

Lead monthly meeting with quality consultants and local market to ensure identification of opportunities and best practices for improvement

Remains current and informed about Stars/HEDIS, NCQA and CMS industry trends

Represent Hedis/Stars initiatives during quarterly operations meetings with health plan payors

Monitor and reconcile metric outages between CenterWell and health plan payors.

Role essentials :

Bachelor's Degree or 5 years equivalent

RN or Health Care Administrator preferred

2-5 years of management experience Medicare Stars experience or HEDIS experience

Previous operational management leadership experience

Proven skills in analyzing data trends and identifying performance improvement opportunities

Strong attention to detail and focus on customer experience and quality

Excellent communication skills

Ability to operate under tight deadlines

Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint

Ability to travel as determined by business needs

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com