The Senior Stars Improvement, Clinical Professional (RN) is responsible for the development, implementation and management oversight of the company's Medicare Stars Program in the Florida region.
*Central and North Florida areas, exclude South Florida area and Panhandle. Far north Florida limit would be Jacksonville
The Senior Stars Improvement Clinical Professional (RN)
Develops programs designed to increase the plan quality.
Medical records reviews will be 40% of role and 60% of role is participating in strategies that will support Humana provider specific measure care gap closure.
Partners with leaders regarding implementation planning. Reviews and communicates results of programs.
Provider non-standard supplemental data trending
Provider level HEDIS in service
Develop and implement measure specific strategies
Provider and Member outreach on focused care gap measures
EMR remote strategy for Humana provider care gap closure on targeted measures
Provider office in person, Zoom virtual or telephonic meetings
Weekly metrics for provider outreach may apply, some Zoom telephonic outreach will entail cold calling to the in-network providers to establish working relationships
Quality/clinical management and population health
HEDIS and Stars performance
Operational improvements
Financial performance and incentive programs
Data sharing and connectivity, interoperability opportunities
Documentation and coding
Additional areas related to provider performance, member experience, market growth, provider experience and operational excellence
In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:
Medical Benefits
Dental Benefits
Vision Benefits
And more
Use your skills to make an impact
Required Qualifications
Licensed Registered Nurse (RN) without restriction in Florida
5 or more years of clinical nursing experience
1 or more years of Medical Records auditing experience, in the past 5 years
1 or more years of provider office and/ or clinic management experience, in the past 5 years
Comprehensive knowledge of Microsoft Office applications, Word and Excel with advanced knowledge of PowerPoint
Excellent presentation and communication skills, both oral and written
Strong relationship building skills as this is a provider-facing role
Strong attention to detail with a focus on process and quality
Valid driver's license with reliable transportation and the ability to travel up to 40% within the region
Preferred Qualifications
Bachelor’s degree in Nursing
3 or more years years of managed care experience
3or more years years of case management experience
Working knowledge of HEDIS/Stars/CMS
Additional Information
Hours for the role are: Monday-Friday 8am-5pm EST
This role is remote/virtual, but candidate may travel to provider offices within region up to 40% and travel to market offices within region for in person meetings
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.