Senior STARS Improvement, Clinical Professional

The Senior Stars Improvement, Clinical Professional This work focuses on areas of clinical emphasis. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

The Senior Stars Improvement, Clinical Professional This work focuses on areas of clinical emphasis. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

• Continue to focus efforts and identify opportunities on performance improvement for assigned providers
• Actively engages provider during virtual visit to facilitate education, HEDIS outcomes, care of members and bi-directional feedback.
• Attends JOCs with providers and participates in active discussions on HEDIS, member care, and clinical/quality outcomes.
• Communicate clinical quality initiatives to assigned providers
• Educate and assist providers in reducing potential preventable events
• Educate providers and staff about Medicaid Consume Assessment of Healthcare Providers and Systems (CAHPS) survey.

• FL RN License
• Must reside in the state of Florida
• Bachelor's degree in nursing
• Experience with Medicare, Medicaid, or dual eligible populations
• Prior experience in a fast-paced insurance or health care setting
• Understanding of healthcare quality measures STARS, HEDIS, etc.
• Experience collaborating with cross-functional teams
• Comprehensive knowledge of Microsoft Office Word, Excel and Power Point
• Proven analytical skills
• Excellent communication skills, both oral and written

• Medical Coding Certification
• Knowledge of Humana's internal policies, procedures, and systems
• Medicaid Health Plan Experience

Work at Home Requirements:
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

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.

$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.

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…