AVP MD Stars and Risk Adjustment Clinical Strategy and Leadership

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Job Information
Humana
AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership
in
Portland
Maine
Description
The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to lead its Provider Support team and associate's responsibilities. HQRI is an organization with over 900 associates that leads Humana's Stars and Risk Adjustment Strategy, operations, and performance nationally.
The Associate VP for Healthcare Quality Reporting and Improvement (HQRI) relies on medical background and industry-standard clinical / coding guidance to ensure physician and healthcare provider education, reporting and materials are accurate and consistent across the enterprise to support regional and corporate strategic initiatives.
Responsibilities
The AVP, MD, Stars and Risk Adjustment Clinical Strategy leads the HQRI Provider Support Team who work in collaboration with key corporate stakeholders and regional teams, to provide ongoing training, reporting, tools and programs to support corporate and regional strategies for physician and healthcare provider education for Risk Adjustment and Stars. In addition, the position provides supportive clinical and coding expertise across the teams in HQRI. This position reports to a Vice President in Healthcare Quality Reporting and Improvement organization and collaborates significantly with the HQRI Senior Leadership Team in planning and executing its Stars and risk adjustment strategy and programs.
This is a remote position with preference given to Central or Eastern time zones.
Major responsibilities include:
Serve as HQRIs clinical industry representative (e.g., Conferences, national vendor or provider partners)
Inform HQRIs provider strategy and increase adoption of Humana's Stars, MRA, and interoperability strategy and programs
Lead a team/organization of 10 associates across three functions: Education of Humana's Market-based associates on how to drive accurate reporting; Provider communications; policies and procedures aligned to those functions
Serve as a coding expert, which may include working through escalations on coding disputes, policy development or refinement, and coordination and education with providers or Humana associates
Required Qualifications
MD or DO degree
A current and unrestricted license in at least one jurisdiction
Board Certified in an approved ABMS Medical Specialty
Excellent communication skills, both written and verbal
5 years of established clinical experience
Knowledge of the managed care industry including Medicare, Medicaid and / or Commercial products
Must be passionate about contributing to an organization focused on maintaining accuracy of coding and documentation to capture the true health status of our members thru risk adjustment initiatives
Experience with quality assurance and/or regulatory compliance
Travel up to 25%
Preferred Qualifications:
Certification in diagnosis coding (must be receive AAPC certification within one year of hire)
Ability to help develop and use data and analytics to drive sustainable results
External communications for physicians and healthcare providers
Prior experience leading teams focusing on the accuracy of medical record documentation and diagnosis coding
Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
Working knowledge of risk adjustment concepts
Internal Medicine, Family Practice, Geriatrics, OBGYN, Hospitalist clinical specialty
Detail oriented and effective listener
Experience with Stars, including HEDIS, CAHPS and HOS
Prior experience in a business function or business consulting role
Additional Information:
Vaccine Policy
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. We also provide free language interpreter services. See our ****

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