The Principal for Stars Care Coordination, Provider Strategy is responsible for developing, executing, and optimizing strategies that engage hospital systems and provider groups to improve performance on key Stars Care Coordination measures. The role will design and implement financial incentive programs targeted at reducing Plan All-Cause Readmission rates and enhancing provider performance on metrics such as Post-Discharge Physician Visit Rate (PCR), Follow-Up after Mental Health Hospitalization (FMC), and Timely Receipt of Care (TRC). Additionally, the incumbent will support performance management initiatives to drive measurable improvements across both hospitals and provider networks.
Key Responsibilities:
Lead the design, implementation, and evaluation of financial incentive programs for hospital systems to reduce Plan All-Cause Readmission rates.
Develop and manage incentive structures for providers to improve performance on PCR, FMC, and TRC metrics.
Partner with internal and external stakeholders to ensure alignment of incentive programs with organizational goals and compliance requirements.
Provide guidance and support to hospitals and providers in understanding Stars Care Coordination measures and best practices for performance improvement.
Monitor, analyze, and report on the effectiveness of financial incentive programs and overall provider performance against Stars metrics.
Support the development and execution of performance management strategies for both hospitals and providers, including performance tracking, feedback, and intervention.
Collaborate cross-functionally with clinical, operational, and analytics teams to ensure coordinated efforts toward Stars rating improvement.
Stay current with industry trends, CMS guidelines, and best practices related to Stars Care Coordination and value-based incentive programs.
Role Essentials
Bachelor’s degree
8 or more years of experience in management consulting, population health strategy, health outcomes strategies and/or provider practice management
2 - 5 years or more of project/people leadership experience
Strong understanding of transitional care management
Experience working directly with provider groups, clinical leaders, or care teams
Experience in advanced primary care or high-performance provider models
Strong data literacy with demonstrated experience using analytics to drive operational insights
Excellent communication, relationship-building, and cross-functional collaboration skills
Ability to independently manage complex initiatives, work across departments, and drive execution without day-to-day oversight
Role Desirables
Experience with population health workflows and drivers of 30-day readmissions
Experience in management consulting and clinical practice (ideal but not required)
Expertise in provider workflow optimization, care transitions, or readmission reduction programs
Familiarity with EHR workflows and system integrations
Demonstrated ability to translate analytics into operationally executable solutions
Additional Information
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 required; 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.
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.
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.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.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.
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.
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.