Quality RN - Atlanta GA

Humana • Atlanta, GA

274d • $71,100 - $97,800 • Onsite

About The Position

The Quality RN Professional is responsible for the development, implementation, and management oversight of the company's Medicare/Medicaid Stars Program. The role involves collaboration with market leadership and the quality improvement team to develop and implement programs designed to increase patient outcomes. The Quality RN Professional will work within assigned center locations and in partnership with existing Quality Improvement Coordinators and Professionals, focusing on various areas including quality/clinical management, HEDIS and Stars performance, operational improvements, financial performance, data sharing, documentation, and coding.

Requirements

• Licensed Registered Nurse (RN) without restriction in applicable state.
• 5+ years of clinical nursing experience.
• Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement.
• Strong knowledge of HEDIS/Stars/CMS.
• Excellent presentation and communication skills, both oral and written.
• Strong relationship building skills.
• Strong attention to detail with a focus on process and quality.
• Comprehensive knowledge of Microsoft Office applications.

Nice To Haves

• Bachelor's Degree in Nursing.
• 3+ years of managed care experience.
• 3+ years of case management experience.
• Bilingual; English and Spanish preferred, not required.

Responsibilities

• Develop and implement the Medicare/Medicaid Stars Program.
• Collaborate with market leadership and quality improvement teams.
• Increase patient outcomes through program implementation.
• Manage provider relationships across quality management and population health.
• Oversee HEDIS and Stars performance.
• Implement operational improvements and financial performance initiatives.
• Facilitate data sharing and connectivity.
• Ensure proper documentation and coding.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off including company and personal holidays, volunteer time off, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree