The RN Senior Stars Improvement, Clinical Consultant / Professional executes the overall Medicare Stars Improvement Program within the market, including development, implementation and management of strategies and relationships with physician groups and internal partners along with supporting and improving financial and quality performance within the contracted working relationship with the health plan.
The RN Senior Stars Improvement Consultant / Professional:
Builds and maintains strong relationships with assigned physician groups to influence execution of recommended strategy, use of self-serve tools and promotion of interoperability solutions
Maintains collaborative relationships with internal partners (Provider Engagement, Finance, Medicare Risk Adjustment, Interoperability, Clinical Team, Contracting, etc.)
Educates physician groups on HEDIS, Patient Safety, Patient Experience, financial performance, instills focus on Stars/Quality performance and collaborates to drive improvement
Develops tailored action plans, maintains timely documentation and effectively communicates actionable insights at the appropriate moments of influence to improve performance
Effectively develops and leads presentations to physician groups to promote performance improvement along the value based continuum
Educates physician groups on reward programs and target metrics and collaborate with them to achieve established goals
Use your skills to make an impact
Required Qualifications
Licensed Registered Nurse (RN) without restriction in Tennessee
Reside in Nashville, Tennessee area
3 or more years of Adult clinical nursing experience
Medicare and/or managed care experience
Comprehensive knowledge of Microsoft Office applications Word, Excel and PowerPoint
Process and Quality improvement experience
Understanding of metrics, trends and the ability to identify gaps in care
Willingness to travel a minimum of 10%
Valid driver's license with reliable transportation
Preferred Qualifications
Bachelor’s degree
Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system
Experience presenting to internal and external customers, including high-level leadership
Experience building relationships with physician groups and influencing execution of recommended strategy
Experience with Medicare Risk Adjustment and/or medical coding
Understanding of Consumer/Patient Experience
Progressive experience with interoperability solutions in Healthcare
Strong attention to detail
Excellent communication skills, both in-person and virtually
Ability to operate under tight deadlines
Proven organizational and prioritization skills and ability to collaborate with multiple departments
Additional Qualifications
Hours will be 8:00am - 5pm CST.
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
Associates 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 associates 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
Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
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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.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.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.