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

Be part of Medicaid’s D-SNP Center of Excellence. This role is responsible for supporting Quality and Stars within Medicaid DSNP markets, serving as a subject matter expert for Stars-related initiatives, and ensuring their effective activation and integration throughout the Insurance Operations organization. This role will be focusing on advancing quality outcomes and access.
Medicaid DSNP Operations encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a comprehensive and high-quality member experience.

In this role, you will identify and engage with Quality and Stars-related initiatives within Medicaid DSNP markets to understand the business strategy, scope, and goals, building a working knowledge to inform identification and validation of potential synergies, business-specific requirements, risks, and integration paths. This role will manage relationships and builds trust with key enterprise partners critical for integrated D-SNP; gaining alignment on cross-asset integration opportunities, identify and implement new initiatives.  Scales best practices and creates standardization opportunities across integrated states. In addition, this role will support the optimization of Stars measures and initiatives that impact integrated D-SNPs; identifying gaps and opportunities for greater collaboration across Medicaid and Medicare segments. This role requires a deep understanding of operations and how it connects with enterprise Stars governance and initiatives.

Role Responsibilities:

• Oversight of related budget, vendor relationships, and program/ project management

• Serve as the primary liaison for Stars initiatives within Medicaid D-SNP, building deep operational knowledge of core functional areas (care coordination, quality, billing, claims, and customer service).

• Supports prioritization and resolution of market issues working across Medicare and Medicaid market teams and Medicare and Medicaid centralized services

• Be the primary business partner  with Medicare Stars organization to identify, understand, and align Stars-related business strategies, objectives, and operational requirements to drive D SNP member experience.

• Enhances and aligns data sharing processes between Medicare and Medicaid Evaluate business processes across Insurance Operations to identify synergies, integration opportunities, and operational risks related to Stars performance and compliance.

• Scales best practices and creates standardization opportunities across integrated states

• Coordinate with analytics and reporting teams to generate actionable insights, enabling data-driven prioritization of operational improvements that directly impact Stars measures.

• Advances integrated care-team approaches across Medicare and Medicaid

• Partner with segment and enterprise Stars leaders to advance cross-functional initiatives, ensuring alignment between operational execution and Stars strategy.

• Maintain a comprehensive inventory of Stars initiatives within Insurance Operations, identifying gaps and facilitating collaboration to maximize impact across all operational areas.

• Lead and support the design, implementation, and optimization of Stars-related programs and processes within Insurance Operations, including performance monitoring and continuous improvement.

• Oversee test-and-learn pilots to validate solutions and measure operational effectiveness, using results to inform broader implementation.

• Develop and deliver regular reports on Stars operational performance to executive leadership, providing clear visibility into progress, challenges, and opportunities.

• Manage budgets, vendor relationships, and project plans to support the successful delivery of Stars-focused operational initiatives.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree

• 5 + years of quality improvement, developing & advancing enterprise strategy, insurance operations experience, i.e.: claims, UM, CM, call center, enrollment, etc.   

• 3+ years of CMS Stars program experience

• Previous leadership experience as a people leader, leading through influence, or leading complex projects with engagement from multiple areas of the company

• Demonstrated track record of ability to tell the story, influence leaders and drive improvement activity in a matrixed organization

• Strong executive presence

• Ability to navigate business intelligence tools to review data insights & making data driven decisions

• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint

Preferred Qualifications

• D-SNP experience

• Medicaid and MLTSS experience

Additional Information

This position is open to working remote with a preference in KY, FL, IL, WI, IN, VA and/or MI

Work at Home Guidance

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$138,900 - $191,000 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.

Application Deadline: 02-05-2026

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.

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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.