Bilingual RN: Care Transitions & Quality Improvement

Humana Inc; Dallas (TX); On-site; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Job summary

Humana Inc. seeks a Clinical Care Nurse (RN) for a clinic-based role focused on improving patient outcomes through effective transitions of care, quality improvement, and engagement with patients and providers.

The position emphasizes Medicare Advantage Stars, HEDIS, and population health management with data-driven interventions. You will perform post-discharge outreach, coordinate follow-up, and collaborate with interdisciplinary teams to enhance care delivery and reduce avoidable

Qualifications

• Must have ADN or BSN.
• Active, unrestricted RN license (state-specific).
• 3+ years of clinical nursing experience with exposure to transitions of care, quality improvement, managed care, or population health management.
• Proficiency with electronic health records (e.g., Athena EMR), data analytics tools (DataHub, Compass Rose, Salesforce HealthCloud) and Microsoft Office Suite.

Responsibilities

• Analyze clinical data and trends from platforms such as Athena EMR and DataHub to identify gaps in care related to Stars and HEDIS measures and Transitions of Care and post-hospitalization needs, prioritizing high-impact opportunities.
• Proactively identify recently discharged inpatient, observation and emergency department patients and coordinate timely post-discharge follow-up in alignment with TOC and Transitional Care Management (TCM) requirements, with the aim of addressing root causes of utilization.

Skills

Bilingual in English and Spanish

RN license

Electronic health records

Data analytics tools

Microsoft Office proficiency

Education

ADN/BSN

Tools

Athena EMR

DataHub

Compass Rose

SalesForce HealthCloud

Job description

Humana Inc. seeks a Clinical Care Nurse (RN) for a clinic-based role focused on improving patient outcomes through effective transitions of care, quality improvement, and engagement with patients and providers.

The position emphasizes Medicare Advantage Stars, HEDIS, and population health management with data-driven interventions. You will perform post-discharge outreach, coordinate follow-up, and collaborate with interdisciplinary teams to enhance care delivery and reduce avoidable