Senior Stars Clinical Consultant RN

Humana • Work at Home - Florida, FL

2d • $78,400 - $107,800 • Remote

About The Position

The Senior Stars Clinical Consultant (RN) is responsible for the implementation and management oversight of the company's Medicare Stars Program in the Florida region. The Senior Stars Clinical Professional (RN) develops programs designed to increase the plan quality. Partners with leaders regarding the implementation of Stars gap closure campaigns.

Requirements

• Licensed Registered Nurse (RN) without restriction in Florida
• Valid driver's license with reliable transportation and the ability to travel up to 30% within the State of Florida
• 5+ years of clinical nursing experience
• 1+ years' electronic medical records systems and Medical Records auditing experience, in the past 5 years
• 1+ years' provider office and/or clinic management experience, in the past 5 years
• Experience visiting providers
• Presentation experience using PowerPoint
• Knowledge of Microsoft Office applications, Word and Excel

Nice To Haves

• Bachelor's degree in nursing
• 3+ years of managed care experience
• 3+ years of case management experience
• Working knowledge of HEDIS/Stars/CMS

Responsibilities

• Lead measure-specific Medicare Stars gap closure campaigns to improve quality performance outcomes
• Conduct medical record reviews, support EMR-based provider gap closure and perform member telephonic outreach
• Engage providers through in-person visits traveling up to 30%, virtual meetings, and phone outreach to build relationships and support care gap closure
• Partner with measure leaders, program leads, vendors, and internal teams to execute Stars initiatives and pilot strategies
• Provide clinical expertise and support provider education, including HEDIS in-service discussions and quality improvement opportunities
• Identify opportunities to improve documentation, coding, supplemental data, interoperability, provider performance, member experience, and operational excellence
• Apply Stars operations knowledge, technical specifications, value sets, coding, and HEDIS gap closure processes to support strategic decision-making

Benefits

• medical
• dental
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior