Senior Stars Clinical Consultant RN

Senior Stars Improvement, Clinical Professional (RN)

This is a hybrid position- requires onsite provider visits up to 40% of the time and is not fully remote. The Senior Stars Improvement Clinical Professional (RN) is responsible for the development, implementation and management oversight of the company's Medicare Stars Program in the Florida region. Ideal candidates will be based in Gainesville or Ocala. Central and North Florida areas, exclude South Florida area and Panhandle. Far north Florida limit would be Jacksonville.

The Senior Stars Improvement Clinical Professional (RN)

• Develops programs designed to increase the plan quality.
• Medical records reviews, EMR remote provider gap closure support will be 30% of role and 30% of role is participating in Stars new pilot strategies that will support Humana provider specific measure care gap closure. – 40% will include provider in person visits.
• Partners with leaders regarding implementation planning. Reviews and communicates results of programs.
• Provider non-standard supplemental data trending
• Provider level HEDIS in service
• Develop and implement measure specific strategies
• Provider and Member outreach on focused care gap measures
• EMR remote strategy for Humana provider care gap closure on targeted measures
• Provider office in person, Zoom virtual or telephonic meetings
• Weekly metrics for provider outreach may apply, some Zoom telephonic outreach will entail cold calling to the in-network providers to establish working relationships
• Quality/clinical management and population health
• HEDIS and Stars performance
• Operational improvements
• Financial performance and incentive programs
• Data sharing and connectivity, interoperability opportunities
• Documentation and coding
• Additional areas related to provider performance, member experience, market growth, provider experience and operational excellence

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in Florida
• 5 or more years of clinical nursing experience
• 1 or more years of in electronic medical records systems and Medical Records auditing experience, in the past 5 years
• 1 or more years of provider office and/ or clinic management experience, in the past 5 years
• 1 or more years' experience visiting providers or members
• 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 40% within the region

Preferred Qualifications

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

Additional Information

• Hours for the role are: Monday-Friday 8am-5pm EST
• This role is remote/virtual, but candidate may travel to provider offices within region up to 40% and travel to market offices within region for in person meetings

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

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.

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.