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

The Quality Improvement Senior Clinical Professional (RN) is responsible for the development, implementation and management oversight of the company's Medicare Stars Program in the SouthEast Florida region (West Palm Beach, Stuart, Jupiter - Treasure Coast/Palm Beach Market).

The Quality Improvement Senior Clinical Professional (RN) develops programs designed to increase the plan quality. Partners with leaders regarding implementation planning. Reviews and communicates results of programs. The Quality Improvement Clinical Professional (RN) (Senior Stars Improvement, Clinical Professional (RN)) represents the scope of health plan/provider relationships across the following areas:

• Provider facing Zoom virtual/telephonic meetings
• Weekly metrics for provider outreach, some Zoom telephonic outreach will entail calling to the in-network providers to establish working relationships
• 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

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• Health Savings Accounts
• Flex Spending Accounts
• Life Insurance
• 401(k)
• PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
• And more

Use your skills to make an impact
 

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in applicable state
• 5+ years' of clinical nursing experience
• 1+ years' experience in a fast-paced healthcare operational role, including hospital, provider or member facing nursing responsibilities
• Experience in provider engagement and relationship management
• Strong understanding of Stars measures and quality improvement initiatives
• Proven ability to influence clinical practice or provider performance
• Comprehensive knowledge of Microsoft Office applications, Word and Excel with advanced knowledge of PowerPoint
• 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
• Valid driver's license with reliable transportation and the ability to travel up to 30% within the region

Preferred Qualifications

• Bachelor’s degree in Nursing
• 3+ years of managed care experience
• 3+ years of case management experience
• Strong knowledge of HEDIS/Stars/CMS

Additional Information

• Hours for the role are: Monday-Friday 8am-5pm EST
• This role is currently remote/virtual but candidate may travel to provider offices within region up to 30% in the near future
• This position will be located in the West Palm Beach, Stuart, Jupiter - Treasure Coast/Palm Beach Market area.

Work at Home/Remote Requirements

Work-At-Home Requirements

• 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 to support Humana applications, per associate.
  • Wireless, Wired Cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership.  (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
  • Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota.  Associates who live and wo