AVP, National Medical Director – Stars and Risk Adjustment

🔥 10 hours ago

🇺🇸 United States – Remote

💵 $246.1k - $344.2k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Provide clinical leadership and strategic direction for STARS and Risk Adjustment initiatives • Drive provider engagement and satisfaction related to risk adjustment and clinical quality programs • Oversee risk adjustment education • Develop, implement, and monitor KPIs, reporting, and education for Regional Vice Presidents and Health Services Directors • Engage and partner with physicians, physician groups, and market leadership • Consult on quality and measurement of care delivery programs • Provide clinical guidance and subject matter expertise across STARS and Risk Adjustment initiatives • Oversee medical direction for Stars self-reporting metrics, including clinical oversight, interpretation, and escalation • Participate in CMS audits with physician-level clinical expertise • Provide targeted provider education to close Stars gaps and improve quality-measure performance • Lead and manage the risk adjustment education team • Collaborate with operations, clinical, analytics, and compliance stakeholders • Oversee education sessions, materials, and resources for internal teams and provider partners • Analyze data and trends to identify process improvements and provider engagement opportunities • Ensure regulatory, policy, and quality compliance • Serve as physician signatory for provider disclosure letters related to modified claims and new diagnoses • Assist with provider reporting, education, and feedback loops supporting accurate documentation and compliant risk adjustment practices

🎯 Requirements

• Advanced clinical degree (MD, DO) required • Demonstrated experience in clinical leadership roles, preferably within managed care, risk adjustment, or quality improvement environments • Experience with risk adjustment and STARS • Ability to lead and develop high-performing teams • Strong communication and relationship-building skills with experience engaging provider organizations • Experience developing and monitoring KPIs, reporting, and educational programs for healthcare leaders • Proficiency in interpreting clinical and quality data to drive performance improvement • Minimum internet speed of 25 Mbps download and 10 Mbps upload for home or hybrid home/office employees • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Occasional travel to Humana offices for training or meetings may be required

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Other wellness and healthcare decision-support opportunities