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Greater Peoria, IL
Greater Peoria, IL

Director, Quality and Risk Adjustment



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Quality Assurance
Posted on Tuesday, February 13, 2024

Become a part of our caring community and help us put health first

The Director, Quality and Risk Adjustment has regional oversight of the development and implementation of the company Medicare/Medicaid Stars and Risk Adjustment Programs. Oversees Stars quality improvement programs and initiatives to increase the plan quality. Has regional oversight of risk adjustment to ensure appropriate implementation of programs and data quality that is submitted to CMS and other governmental agencies. The Director, Quality and Risk Adjustment requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

The Director, Quality and Risk Adjustment is responsible for the successful execution of Stars, Risk Adjustment strategy and Network Performance Management within a designated region. Identifies regional nuances that have provider impact combined with an operational mindset. This opportunity requires the ability to effectively partner across the Region and with the Corporate Stars and MRA organizations, a highly inclusive leadership style, and the ability to lead and develop a team with diverse experience.

The Director, Quality and Risk Adjustment typical responsibilities, but not limited to:

  • Implements strategic plans, drives goals and objectives, and improves performance.
  • Provides input into functions strategy.
  • Support Interoperability goals.
  • Partner w/ Director Provider Engagement to influence provider relationships and performance outcomes.

Desired Skillet:

  • Experience aligning goals to strategy, organize resources, prioritize initiatives
  • Collaborative. Ability to execute within matrix-style organizational structure.
  • Demonstrated ability to efficiently operate within tight timelines and to pivot as business needs dictate
  • Ability to lead through influence

Use your skills to make an impact

Required Qualifications:

  • Bachelor's Degree
  • 3+ years of Stars and/or Risk Adjustment programs experience
  • Prior experience in market strategy and decisions based on Stars and Risk Adjustment considerations
  • 3+ years of experience directly leading and developing teams
  • Provider engagement/Provider performance experience or Network Operations experience
  • Prior experience in analyzing and interpreting data trends with the ability to understand and effectively anticipate business impact
  • This is a remote position, however, TX, AR, OK Region experience preferred

Preferred Qualifications:

  • Knowledge of Stars and CMS quality measures
  • Knowledge of CMS Medicare Risk Adjustment model
  • Advanced degree
  • Strong financial acumen
  • Previous experience in a health solutions organization

Additional Information

Location: remote, however, TX, AR, OK location preferred

Work-At-Home Requirements

  • Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.
As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule

Scheduled Weekly Hours


Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$149,800 - $206,100 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

This job is no longer accepting applications

See open jobs at Humana.