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

The Stars Improvement, Clinical Professional (RN) is responsible for the development, implementation and management oversight of the Primary Care Organization’s Stars Program in the South Florida market. The Stars Improvement, Clinical Professional (RN) works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. 

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 Florida
• 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 or Creole 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 This role is part of Humana's Driver safety program and therefore requires an individual to have:

• 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 HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain va