Senior STARS Improvement, Clinical Professional
About The Position
This work focuses on areas of clinical emphasis. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Continue to focus efforts and identify opportunities on performance improvement for assigned providers Actively engages provider during virtual visit to facilitate education, HEDIS outcomes, care of members and bi-directional feedback. Attends JOCs with providers and participates in active discussions on HEDIS, member care, and clinical/quality outcomes. Communicate clinical quality initiatives to assigned providers Educate and assist providers in reducing potential preventable events Educate providers and staff about Medicaid Consume Assessment of Healthcare Providers and Systems (CAHPS) survey.
Requirements
- FL RN License
- Must reside in the state of Florida
- Bachelor's degree in nursing
- Experience with Medicare, Medicaid, or dual eligible populations
- Prior experience in a fast-paced insurance or health care setting
- Understanding of healthcare quality measures STARS, HEDIS, etc.
- Experience collaborating with cross-functional teams
- Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
- Proven analytical skills
- Excellent communication skills, both oral and written
Nice To Haves
- Medical Coding Certification
- Knowledge of Humana's internal policies, procedures, and systems
- Medicaid Health Plan Experience
Responsibilities
- Continue to focus efforts and identify opportunities on performance improvement for assigned providers
- Actively engages provider during virtual visit to facilitate education, HEDIS outcomes, care of members and bi-directional feedback.
- Attends JOCs with providers and participates in active discussions on HEDIS, member care, and clinical/quality outcomes.
- Communicate clinical quality initiatives to assigned providers
- Educate and assist providers in reducing potential preventable events
- Educate providers and staff about Medicaid Consume Assessment of Healthcare Providers and Systems (CAHPS) survey.
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
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What This Job Offers
Job Type
Full-time
Career Level
Senior
