Humana · 6 days ago
D-SNP Stars & Clinical Principal
United States
Full-time
Remote
Senior Level
$139K/yr - $191K/yr
5+ years expHumana is committed to putting health first and is seeking a D-SNP Stars & Clinical Principal to support quality and Stars initiatives within Medicaid DSNP markets. The role involves managing relationships, optimizing Stars measures, and ensuring effective integration across Insurance Operations.
Health CareHealth InsuranceInsuranceVenture Capital
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
Qualification
Required
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
D-SNP experience
Medicaid and MLTSS experience
Benefits
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Caleb Gallifant
Chief Operating Officer, CenterWell Home Health
Recent News
2026-01-16
2026-01-16
Company data provided by crunchbase