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

The Nurse Senior Stars Improvement, Clinical Professional/ Consultant contributes to the development, implementation, and management of the company's Medicare/Medicaid Five-Star Quality Rating System. The Senior Stars Improvement, Clinical Professional works directly with provider groups, Management Services Organizations (MSOs) and organizational leaders to impact Centers for Medicare & Medicaid Services (CMS) Star Rating categories - including but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), Patient Safety, and Patient Experience.

The Nurse Senior Stars Improvement, Clinical Professional / Consultant focuses on areas of clinical emphasis related to the CMS Stars Program.

• Possess a moderate to in-depth understanding of Stars Program operations.

• Able to effectively interpret and communicate metrics and analytical data that leads to favorable outcomes.

• Relationship building and implementation of best practices to drive results within a provider network and MSO as it relates to clinical HEDIS measures.

• Experience in preparing and delivering training sessions, educational materials, performance reports, and presentations.

• Knowledge of the National Committee of Quality Assurance (NCQA) technical specifications and codes within attributed value sets

• Detail oriented and willingness to learn the more minute parts of HEDIS measures and gap closure processes with limited guidance and direction

Use your skills to make an impact
 

Required Qualifications

• Licensed Professional Nurse or Registered Nurse

• 3 or more years of Medicare experience

• 3 or more years of CMS Stars and HEDIS experience

• Strong knowledge of Microsoft Office XP products (Word, Excel, PowerPoint)

• Proven analytical skills (i.e., trending and analysis of healthcare data)

• Local travel 25%, based on business needs.

• Resides in Orlando, FL area.

Preferred Qualifications

• Case Management, Accreditation or Clinical Administrative experience

• User experience with data analysis tools (e.g. Power BI)

• Excellent communication skills, both oral and written

• Prior experience in a fast-paced insurance or healthcare setting

• Able to work independently, managing own schedule, and taking initiative in own tasks and responsibilities.

Additional Information

​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 Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition numb