AVP, Stars and Risk Adjustment – National Medical Director
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The Associate Vice President, Medical Risk Adjustment and Provider Engagement, is responsible for providing clinical leadership and strategic direction to support the organization’s STARS and Risk Adjustment initiatives. This leader will drive provider engagement and satisfaction, oversee risk adjustment education, and develop, implement, and monitor key performance indicators (KPIs), reporting, and education for Regional Vice Presidents and Health Services Directors.The Associate VP, Market Consultation/Partnership engages and partners with physicians, physician groups, and market leadership to drive initiatives. Influences and consults on matters related to quality and measurement of care delivery programs with a market(s). Decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes, and develops and implements strategic plans for the scope of management that are aligned with the Segment or Business strategy.
Key Responsibilities:
Provide clinical guidance and subject matter expertise across all STARS and Risk Adjustment initiatives to ensure alignment with organizational objectives and regulatory requirements.
Demonstrate high responsiveness to providers, with the goal of increasing provider engagement and satisfaction related to risk adjustment and clinical quality programs.
Serve as the overseeing medical director for Stars self-reporting metrics, including clinical oversight, interpretation, and escalation of issues requiring physician leadership.
Participate in CMS audits related to Stars and risk adjustment activities, complementing technical and operational audit support with physician-level clinical expertise.
Provide targeted provider education on clinical and operational areas needed to close Stars gaps and improve performance on quality measures.
Lead and manage a team dedicated to supporting risk adjustment education, ensuring that materials and communications are accurate, timely, and effective.
Develop, implement, and monitor KPIs for Regional Vice Presidents and Health Services Directors, ensuring that performance metrics, reporting processes, and educational initiatives support continuous improvement in risk adjustment outcomes and provider engagement.
Collaborate cross-functionally with internal stakeholders, including operations, clinical, analytics, and compliance teams, to drive the success.
Oversee the design and delivery of education sessions, materials, and resources for both internal teams and provider partners.
Analyze data and trends to identify opportunities for process improvements andenhancedprovider engagement strategies.
Ensure that all risk adjustment activities are conducted in compliance with applicable regulations, internal policies, and quality standards.
Serve as the physician signatory for provider disclosure letters related to risk adjustment when Humana modifies a claim with a new diagnosis, ensuring communications are clinically appropriate and compliant.
Assist with provider reporting, provider education, and feedback loops to support accurate documentation, improved Stars performance, and compliant risk adjustment practices.
Use your skills to make an impact
Qualifications:
Advanced clinical degree (MD, DO) required.
Demonstrated experience in clinical leadership roles, preferably within managed care, risk adjustment, or quality improvement environments.
Risk adjustment and Stars experience
Proven 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.
Scheduled Weekly Hours
40Pay 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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$246,100 - $344,200 per yearThis 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 09-29-2026About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.