Quality Improvement RN - Chesapeake, VA

Become a part of our caring community and help us put health first

The Stars Improvement, Clinical Professional 2 is responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Stars Improvement, Clinical Professional 2 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 quality improvement team to develop and implement programs designed to increase the 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 the following areas:

• 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

Use your skills to make an impact

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in Virginia or Compact
• 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

Preferred Qualification

• Bachelor’s Degree in Nursing
• 3+ years of managed care experience
• 3+ years of case management experience
  
  Bilingual;
  English and Spanish preferred, not required

Additional Information

• Hours for the role are Monday-Friday 8am-5pm local time zone
• This role is based within the provider office with regular rotation through each center within the assigned territory.

Driver's License, Reliable Transportation, Insurance

• a valid state driver's license,
• carry insurance in accordance with the state minimum required limits, or $25,000/$25,000/10,000 whichever is higher, and
• a reliable vehicle.

Tuberculosis (TB) screening

This role is considered member facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 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.

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