Stars Improvement RN - North Charleston SC

Humana • North Charleston, SC

283d • $71,100 - $97,800

About The Position

The Stars Improvement, Clinical Professional 2 is responsible for the development, implementation, and management oversight of the company's Medicare/Medicaid Stars Program. The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Stars Improvement Clinical Professional (RN) collaborates with market leadership and the quality improvement team to develop and implement programs designed to increase patient outcomes. Work is performed within the associate's assigned center locations and in collaboration with existing Quality Improvement Coordinators and Professionals and in close partnership with market and center teams. The Stars Improvement, Clinical Professional (RN) represents the scope of provider relationships across various areas including Quality/clinical management and population health, HEDIS and Stars performance, operational improvements, financial performance and incentive programs, data sharing and connectivity, documentation and coding, and 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.
• 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 as this is a provider-facing role.
• 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, implement, and manage the Medicare/Medicaid Stars Program.
• Collaborate with market leadership and quality improvement teams.
• Increase patient outcomes through program development.
• Work within assigned center locations and collaborate with Quality Improvement Coordinators.
• Represent provider relationships across quality management, HEDIS, and Stars performance.
• Engage in 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