Nurse Clinical Lead - Provider Education

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The Nurse Clinical Lead reports to, and partners closely with, the National Medical Director, Risk Adjustment and Stars. They support corporate and regional strategies for provider success in Medicare Stars, Risk‑Adjustment (MRA), and Interoperability. This individual provides clinical and coding expertise and serves a vital individual contributor role. They provide clinical guidance for programs, policies, and educational materials to optimize provider performance in these domains.

• Inform clinical strategy and increase adoption of Humana's Stars, MRA, and Interoperability programs

• Serve as a clinical coding expert, which may include working through escalations on coding disputes, policy development or refinement, and coordination and education with providers or Humana associates

• Serve as a clinical consultant and subject‑matter expert in MRA and Stars across the Quality and Cost Strategy organization

• Serve as the first‑line clinical resource as appropriate for the MRA, Stars, and Interoperability teams

• Co‑develop internal and external provider education materials for MRA, Stars, Utilization Management and Trend

• Educate and train market associates

• Provide Clinical Support to Provider Education, Communication, and Strategy teams – also reporting to the National Medical Director, Risk Adjustment and Stars

• Registered Nurse (RN)

• At least 5 years of clinical experience in a healthcare setting

• Medical Coding Certification (CPC or equivalent)

• Strong knowledge of Medicare Risk Adjustment

• Strong knowledge of Medicare Stars

• Significant experience educating and influencing the behavior of healthcare providers

• Proven track‑record of driving provider practice improvement, including in MRA and Stars

• Exceptional communication and interpersonal skills with the ability to quickly build rapport at all levels within an organization

• Bachelor of Science in Nursing (BSN)

• Subject matter expertise in Medicare Risk Adjustment

• Subject matter expertise in Medicare Stars

• Familiarity with Interoperability products and programs

• Strong Electronic Health Record experience

• Advanced Risk Adjustment Coding certification (e.g. CRC)

• Subject matter expertise in Medicare Stars

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self‑provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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.

40

$104,000 - $143,000 per year

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

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, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities.

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…