AVP, Stars and Risk Adjustment – National Medical Director

About this role

Become a part of our caring community   The Associate Vice President, Medical Risk Adjustment and Provider Engagement, is responsible for providing clinical leadership and strategic direction to support the organization’s STARS and Risk Adjustment initiatives. This leader will drive provider engagement and satisfaction, oversee risk adjustment education, and develop, implement, and monitor key performance indicators (KPIs), reporting, and education for Regional Vice Presidents and Health Services Directors.

The Associate VP, Market Consultation/Partnership engages and partners with physicians, physician groups, and market leadership to drive initiatives. Influences and consults on matters related to quality and measurement of care delivery programs with a market(s). Decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes, and develops and implements strategic plans for the scope of management that are aligned with the Segment or Business strategy.

Key Responsibilities:  

• Provide clinical guidance and subject matter expertise across all STARS and Risk Adjustment initiatives to ensure alignment with organizational objectives and regulatory requirements.  

• Demonstrate high responsiveness to providers, with the goal of increasing provider engagement and satisfaction related to risk adjustment and clinical quality programs.  

• Serve as the overseeing medical director for Stars self-reporting metrics, including clinical oversight, interpretation, and escalation of issues requiring physician leadership.  

• Participate in CMS audits related to Stars and risk adjustment activities, complementing technical and operational audit support with physician-level clinical expertise .  

• Provide targeted provider education on clinical and operational areas needed to close Stars gaps and improve performance on quality measures.  

• Lead and manage a team dedicated to supporting risk adjustment education, ensuring that materials and communications are accurate, timely, and effective.  

• Develop, implement, and monitor KPIs for Regional Vice Presidents and Health Services Directors, ensuring that performance metrics, reporting processes, and educational initiatives support continuous improvement in risk adjustment outcomes and provider engagement.  

• Collaborate cross-functionally with internal stakeholders, including operations, clinical, analytics, and compliance teams, to drive the success.  

• Oversee the design and delivery of education sessions, materials, and resources for both internal teams and provider partners.  

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

• Ensure that all risk adjustment activities are conducted in compliance with applicable regulations, internal policies, and quality standards.  

• Serve as the physician signatory for provider disclosure letters related to risk adjustment when Humana modifies a claim with a new diagnosis, ensuring communications are clinically appropriate and compliant.  

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

Use your skills to make an impact   Qualifications:  

• Advanced clinical degree (MD, DO) required.  

• Demonstrated experience in clinical leadership roles, preferably within managed care, risk adjustment, or quality improvement environments.  

• Risk adjustment and Stars experience  

• Proven ability to lead and develop high-performing teams.  

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

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

• Proficiency in interpreting clinical and quality data to drive performance improvement.  

Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   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.   $246,100 - $344,200 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 09-29-2026 About us   About Hu

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