Quality Improvement Senior Clinical Registered Nurse

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

The Quality Improvement Senior Clinical Professional (RN) is responsible for the implementation and management oversight of the company's Medicare Stars Program in the Central FL/Orlando region.

The Quality Improvement Senior Clinical Professional (RN) develops programs designed to increase the plan quality. Partners with leaders regarding implementation planning. Reviews and communicates results of programs.

The Quality Improvement Clinical Professional (RN), also known as Senior Stars Improvement, Clinical Professional (RN), represents the scope of health plan/provider relationships. This scope spans across the following areas. The Quality Improvement Clinical Professional (RN) will report to the Manager, Stars Improvement, Clinical.

• Provider facing Zoom virtual/telephonic meetings

• 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

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in applicable state

• 5+ years of clinical nursing experience

• 1+ years' experience in a healthcare operational role, including hospital, provider or member facing nursing responsibilities

• Experience in provider engagement and relationship management

• Experience with Stars measures and quality improvement programs

• Proven ability to influence clinical practice or provider performance

• Comprehensive knowledge of Microsoft Office applications, Word and Excel with advanced knowledge of Power Point

• Valid driver's license with reliable transportation and the ability to travel up to 30% within the region

Preferred Qualifications

• Bachelor's degree in nursing

• 3+ years of managed care experience

• 3+ years of case management experience

• Knowledge of HEDIS/Stars/CMS

Use your skills to make an impact

Additional Information

• Hours for the role are:
  Monday-Friday 8am-5pm EST

• This role is currently remote/virtual with travel to provider offices within region up to 30%

• This position will be located in the Central FL/Orlando region.

Benefits statement:

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

Health benefits effective day 1

Paid time off, holidays, volunteer time and jury duty pay

Recognition pay

401(k) retirement savings plan with employer match

Tuition assistance

Scholarships for eligible dependents

Parental and caregiver leave

Employee charity matching program

Network Resource Groups (NRGs)

Career development opportunities

Driving Statement

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

Hire Vue Statement:

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.

If you are selected, you will receive correspondence inviting you to participate in a Hire Vue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 10-15 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.

Internet Statement

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid…