Manager Quality Audit CenterWell Stars HEDIS Improvement and Operations
Company name
Humana Inc.
Location
Houston, TX, United States
Employment Type
Full-Time
Industry
Manager, Quality, Audit
Posted on
Aug 13, 2021
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
Employer job 
90 Day Old Job 
