AVP Stars and Risk Adjustment National Medical Director

1 week ago


Colorado Springs, United States Humana Inc. Full time
AVP Stars and Risk Adjustment National Medical Director

Employment Type: Full-Time

Posted on: Apr 28, 2023

Profile

Humana is seeking a talented Physician executive that can contribute to Humana's national planning and operations for Risk Adjustment, Stars, and Interoperability. This role carries a set of individual contributor and leadership responsibilities.

Responsibilities

  1. Inform and support HQRI's provider strategy across Stars, Risk Adjustment, and Interoperability.
  2. Serve as a coding expert to manage escalations or establish compliant policies.
  3. Contribute as a clinical industry representative.
  4. Lead HQRI's Provider Support team (PST) that drives national provider education strategy and operations.
  5. Support corporate and regional strategies for physician and healthcare provider education or operations for Risk Adjustment and Stars.
  6. Provide supportive clinical and coding expertise across the teams in HQRI.
  7. Support interoperability efforts.

Required Qualifications

  1. MD or DO degree.
  2. A current and unrestricted license in at least one jurisdiction.
  3. Board Certified in an approved ABMS Medical Specialty.
  4. Excellent communication skills, both written and verbal.
  5. 5 years of established clinical experience.
  6. Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products.
  7. Passionate about healthcare quality and maintaining accuracy of coding and documentation.
  8. Experience with quality assurance and/or regulatory compliance.
  9. Travel up to 25%.

Preferred Qualifications

  1. Certification in diagnosis coding (must receive AAPC certification within one year of hire).
  2. Ability to develop and use data and analytics to drive sustainable results.
  3. Prior experience leading teams focusing on the accuracy of medical record documentation and diagnosis coding.
  4. Medical management experience with health insurance organizations, hospitals, and other healthcare providers.
  5. Working knowledge of risk adjustment concepts.
  6. Detail-oriented and effective listener.
  7. Experience with Stars, including HEDIS, CAHPS, and HOS.
  8. Prior experience in a business function or business consulting role.

Additional Information

This is a remote position with travel expectations up to 25%. Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours: 40

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.

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  • Colorado Springs, Colorado, United States Humana Inc. Full time

    Job SummaryWe are seeking a highly skilled Physician executive to lead our national planning and operations for Risk Adjustment, Stars, and Interoperability. This role will require strong clinical expertise, leadership skills, and the ability to drive sustainable results.

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