Senior RN STARS Improvement Consultant - Remote Eligible

Become a Part of Our Caring Community and Help Us Put Health First

The Nurse Senior Stars Improvement, Clinical Professional/Consultant contributes to the development, implementation, and management of the company's Medicare/Medicaid Five-Star Quality Rating System. The Senior Stars Improvement, Clinical Professional works directly with provider groups, Management Services Organizations (MSOs) and organizational leaders to impact Centers for Medicare & Medicaid Services (CMS) Star Rating categories - including but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), Patient Safety, and Patient Experience.

The Nurse Senior Stars Improvement, Clinical Professional / Consultant focuses on areas of clinical emphasis related to the CMS Stars Program.

Responsibilities include:

• Possess a moderate to in-depth understanding of Stars Program operations.
• Able to effectively interpret and communicate metrics and analytical data that leads to favorable outcomes.
• Relationship building and implementation of best practices to drive results within a provider network and MSO as it relates to clinical HEDIS measures.
• Experience in preparing and delivering training sessions, educational materials, performance reports, and presentations.
• Knowledge of the National Committee of Quality Assurance (NCQA) technical specifications and codes within attributed value sets.
• Detail oriented and willingness to learn the more minute parts of HEDIS measures and gap closure processes with limited guidance and direction.

Required Qualifications:

• Licensed Professional Nurse or Registered Nurse
• 3 or more years of Medicare experience
• 3 or more years of CMS Stars and HEDIS experience
• Strong knowledge of Microsoft Office XP products (Word, Excel, PowerPoint)
• Proven analytical skills (i.e., trending and analysis of healthcare data)
• Local travel 25%, based on business needs.
• Resides in Orlando, FL area.

Preferred Qualifications:

• Case Management, Accreditation or Clinical Administrative experience
• User experience with data analysis tools (e.g. Power BI)
• Excellent communication skills, both oral and written
• Prior experience in a fast-paced insurance or healthcare setting
• Able to work independently, managing own schedule, and taking initiative in own tasks and responsibilities.

Additional Information:

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work at Home Guidance:

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours 40

Pay Range $78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits:

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer:

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.