Senior Stars Improvement, Clinical Professional

Humana • Clearwater, FL

14d • Hybrid

About The Position

Become a part of our caring community and help us put health first This role is currently remote with travel to provider offices within region The Quality Improvement Senior Clinical Professional (RN) is responsible for the development, implementation and management oversight of the company's Medicare Stars Program in the West Coast Tampa region (Clearwater, St. Petersburg, Palm Harbor, Dunedin) The Quality Improvement Senior Clinical Professional (RN) develops programs designed to increase the plan quality. Partners with leaders regarding implementation planning. Reviews and communicates results of programs. The Quality Improvement Clinical Professional (RN) (Senior Stars Improvement, Clinical Professional (RN)) represents the scope of health plan/provider relationships across the following areas: Provider facing Zoom virtual/telephonic meetings Quality/clinical management and population health HEDIS and Stars performance Operational improvements Financial performance and incentive programs Data sharing and connectivity Documentation and coding Additional areas related to provider performance, member experience, market growth, provider experience and operational excellence

Requirements

• Licensed Registered Nurse (RN) without restriction in applicable state
• 5+ years of clinical nursing experience
• 1+ years' experience in a fast-paced healthcare operational role, including hospital, provider or member facing nursing responsibilities
• Experience in provider engagement and relationship management
• Strong understanding of Stars measures and quality improvement initiatives
• Proven ability to influence clinical practice or provider performance
• 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 30% within the region

Nice To Haves

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

Benefits

• Humana offers a variety of benefits to promote the best health and well-being of our employees and their families.
• We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:
• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees