AVP, National Medical Director – Stars and Risk Adjustment

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide clinical leadership and strategic guidance for STARS and Risk Adjustment initiatives.

• Enhance provider engagement and satisfaction concerning risk adjustment and clinical quality programs.

• Supervise risk adjustment education efforts.

• Develop, implement, and track KPIs, reporting, and educational initiatives for Regional Vice Presidents and Health Services Directors.

• Collaborate and engage with physicians, physician groups, and market leaders.

• Offer consultation on quality and measurement of care delivery programs.

• Deliver 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 processes.

• Participate in CMS audits, providing physician-level clinical expertise.

• Deliver targeted provider education to address Stars gaps and enhance quality-measure performance.

• Lead and manage the risk adjustment education team.

• Collaborate with operations, clinical, analytics, and compliance stakeholders.

• Oversee educational sessions, materials, and resources for internal teams and provider partners.

• Analyze data and trends to identify opportunities for process improvements and provider engagement.

• Ensure compliance with regulatory, policy, and quality standards.

• Serve as the physician signatory for provider disclosure letters regarding modified claims and new diagnoses.

• Assist with provider reporting, education, and feedback loops to support accurate documentation and compliant risk adjustment practices.

⛳️ Requirements

• An advanced clinical degree (MD, DO) is required.

• Proven experience in clinical leadership roles, ideally within managed care, risk adjustment, or quality improvement settings.

• Familiarity with risk adjustment and STARS programs.

• Ability to lead and cultivate high-performing teams.

• Exceptional communication and relationship-building skills with experience in engaging provider organizations.

• Experience in developing and monitoring KPIs, reporting, and educational programs for healthcare leaders.

• Proficient in interpreting clinical and quality data to drive performance improvements.

• Minimum internet speed of 25 Mbps download and 10 Mbps upload for home or hybrid home/office employees.

• Capability 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.

• Additional wellness and healthcare decision-support opportunities.