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

CenterWell is seeking a Medicare Quality Lead to support its original Medicare business and Accountable Care Organization (ACO). Under general direction and supervision from the ACO Director, this role will be responsible for strategy, execution, and performance of all quality measurement and reporting activities. Quality Lead will ensure successful performance across CMS APMs and quality programs such as MSSP, ACO REACH, LEAD, MIPS and others. Additionally, this role requires a deep understanding of the Medicare APP / QPP program including eCQM, Medicare CQM, and MIPS reporting. Leads and directs continuous quality improvement initiatives and works with various stakeholders on measure-level accountability and gap closure - partnering specifically with clinical, analytics, operations, and provider engagement teams to optimize outcomes and shared savings. Lastly, manage relationship with third-party quality registry to ensure completeness with data collection, submission, reporting, and monitoring.

ESSENTIAL DUTIES:

Quality Strategy & Program Leadership:

• Own quality strategy for the ACO; align to CMS program requirements and organizational goals
• Translate CMS quality measures into actionable clinical and operational workflows
• Lead annual quality planning, goal setting, and performance forecasting
• Serve as the main internal subject matter expert on ACO quality programs.
• CMS Quality Reporting & Compliance:
• Oversee quality reporting for MSSP (eCQMs, CAHPS, administrative measures)
• Oversee quality reporting for ACO REACH / LEAD (quality withhold / earn-back accountability and performance measures)
• Oversee MIPS / APM quality reporting for non-qualified APM / ACO participants
• Ensure compliance with CMS technical specifications, submission deadlines, and audit requirements
• Coordinate w/ quality registry to ensure accurate on-time submission; validate output
• Lead CMS audits, data validation, and corrective action plans

Performance Monitoring & KPIs

• Monitor measure performance at ACO, practice, and patient levels
• Develop and monitor KPIs
• Work closely with operations and provider engagement teams to identify and close gaps
• Interpret performance trends and communicate insights to executive leadership

Clinical Quality Improvement:

• Design and implement quality improvement initiatives (i.e. preventive care, chronic disease management, care transitions) - align clinical programs / interventions to measures that materially impact performance
• Collaborate with care management, population health and informatics teams embed quality into workflows
• Use data-driven interventions to close care gaps and improve patient outcomes

Provider Engagement & Education:

• Educate providers and provider engagement teams on quality measures and documentation requirements
• Surface performance results and improvement opportunities
• Provide performance updates and training sessions, as needed

Assure that standards of practice and policies are compliant with the ACO contractual requirements and other contractual and regulatory guidelines and standards

Ensure ACO programs are administered and configured and loaded properly; oversee key operational processes; identify opportunities for performance improvement, and provide regular performance updates

Oversee ACO wholly owned participant provider segment including key processes, programs, and performance; liaise with market teams

Manage ACO governance process, including the Center Well ACO Board

Provide ACO strategy and planning support; coordinate closely with M&A team on ACO integration planning for acquired provider groups

Prepare executive level presentations that highlight business performance and opportunities

Develop, prepare, and interpret reports. Write basic SQL queries to pull data and build reports. Coordinate with Business Intelligence Lead and support ad hoc reporting.

Develop basic modeling and business case analysis, work closely with Finance and Data teams

Coordinate with ACO Lead overseeing the IPA / Affiliate business segment

Adept at forming strong relationships with diverse teams and personalities through effective trust building and collaboration; highly organized, demonstrated ability to show meticulous attention to detail

Use your skills to make an impact
 

STANDARD REQUIREMENTS:

1. Supports the Mission, Value and Vision of CenterWell

2. Exhibits excellent customer service skills and behaviors toward internal and external customers and co-workers

3. Supports and participates in a collaborative team-oriented environment – cooperates and works together with all co-workers, plans and completes job duties, uses appropriate communications in sensitive and emotional situations and follows up as appropriate regarding reported complaints, problems and concerns.

4. Supports, cooperates with and demonstrates safe work practices and attitudes, follows safety rules – including universal precautions - reports and prevents/corrects unsafe conditions and behaviors, and participates in organizational and departmental safety programs.

5. Completes all required compliance standards that may be department specific and/or identified by the organization.

Required Qualifications:

• Bachelor’s degree required; master’s degree preferred (MPH, MHA, MBA, or related)
• 5+ years of experience in healthcare quality, population health, or value-based care
• Direct experience with CMS ACO quality programs (MSSP and / or ACO REACH) strongly preferred)
• Deep knowledge of CMS quality measures, specifications, and quality reporting (eCQM / CQM)
• Familiarity with EMR systems and quality reporting workflows
• Strong understanding of value-based payment models and shared savings mechanics
• Familiarity with healthcare industry including value-based care, health plans, health systems, Medicare, accountable care, population health, medical group management / practice management, or Management Service Organizations (MSOs)

Preferred Education and/or Work Experience:

• Nursing licensure preferred (RN, LPN)
• Experience leading quality programs for large group practice or ACO

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.

 

$104,000 - $143,000 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.

About us
 

About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.

About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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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.