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

The Quality RN Professional/Stars Improvement, Clinical Professional 2 responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Stars Improvement, Clinical Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Stars Improvement Clinical Professional (RN) collaborates with market leadership, and quality improvement team to develop and implement programs designed to increase 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 applicable state 

• 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 preferred, not required 

 

 

Additional Information 

• Hours for the role: 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. 

• This role is considered patient 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.

• This role is part of CenterWell’s driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or wh