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

The RN Senior Stars Improvement, Clinical Consultant / Professional executes the overall Medicare Stars Improvement Program within the market, including development, implementation and management of strategies and relationships with physician groups and internal partners along with supporting and improving financial and quality performance within the contracted working relationship with the health plan.

The RN Senior Stars Improvement Consultant / Professional:

• Builds and maintains strong relationships with assigned physician groups to influence execution of recommended strategy, use of self-serve tools and promotion of interoperability solutions

• Maintains collaborative relationships with internal partners (Provider Engagement, Finance, Medicare Risk Adjustment, Interoperability, Clinical Team, Contracting, etc.)

• Educates physician groups on HEDIS, Patient Safety, Patient Experience, financial performance, instills focus on Stars/Quality performance and collaborates to drive improvement

• Develops tailored action plans, maintains timely documentation and effectively communicates actionable insights at the appropriate moments of influence to improve performance 

• Effectively develops and leads presentations to physician groups to promote performance improvement along the value based continuum

• Educates physician groups on reward programs and target metrics and collaborate with them to achieve established goals

Use your skills to make an impact
 

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in Tennessee

• Reside in Nashville, Tennessee area

• 3 or more years of Adult clinical nursing experience

• Medicare and/or managed care experience

• Comprehensive knowledge of Microsoft Office applications Word, Excel and PowerPoint

• Process and Quality improvement experience

• Understanding of metrics, trends and the ability to identify gaps in care

• Willingness to travel a minimum of 10%

• Valid driver's license with reliable transportation

Preferred Qualifications

• Bachelor’s degree

• Understanding of NCQA HEDIS measures, PQA Measures, CMS Star Rating System and CAHPS/HOS survey system

• Experience presenting to internal and external customers, including high-level leadership

• Experience building relationships with physician groups and influencing execution of recommended strategy

• Experience with Medicare Risk Adjustment and/or medical coding

• Understanding of Consumer/Patient Experience

• Progressive experience with interoperability solutions in Healthcare

• Strong attention to detail

• Excellent communication skills, both in-person and virtually

• Ability to operate under tight deadlines

• Proven organizational and prioritization skills and ability to collaborate with multiple departments

Additional Qualifications

Hours will be 8:00am - 5pm CST.

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Ho