Clinical Care RN: Transitions & Quality Champion

humana; Palm Coast (FL); On-site; USD 68,000 - 86,000; Full time

Job summary

Humana is seeking a Clinical Care Nurse (RN) for a clinic-based role in Palm Coast, FL. You will support safe Transitions of Care, reduce avoidable ED visits, and help drive Medicare Advantage Stars and quality performance.

You will analyze clinical data in Athena EMR and DataHub, conduct outreach by phone, telehealth or in-clinic visits, and collaborate with providers and the care team to close care gaps while maintaining HIPAA.

Qualifications

• Must hold an RN license in Florida
• 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 and data analytics tools; willingness to complete BLS

Responsibilities

• Analyze clinical data from Athena EMR and DataHub to identify gaps in care related to Stars and TOC
• Proactively identify recently discharged patients and coordinate timely post-discharge follow-up
• Conduct targeted outreach via phone, telehealth, and in-clinic visits to educate on preventive care and chronic disease management
• Coordinate with providers and care teams to prevent readmissions and avoidable ED visits
• Collaborate with interdisciplinary teams to implement evidence-based interventions and optimize workflows
• Document all outreach and clinical interactions in the medical record per CMS standards
• Participate in center huddles and quality improvement activities
• Maintain HIPAA confidentiality and safety measures

Skills

Analytical thinking

Care coordination

Clinical judgment

Data-driven

Education

ADN

BSN

Tools

Athena EMR

DataHub

Compass Rose

Salesforce HealthCloud

Microsoft Office

Job description

Humana is seeking a Clinical Care Nurse (RN) for a clinic-based role in Palm Coast, FL. You will support safe Transitions of Care, reduce avoidable ED visits, and help drive Medicare Advantage Stars and quality performance.

You will analyze clinical data in Athena EMR and DataHub, conduct outreach by phone, telehealth or in-clinic visits, and collaborate with providers and the care team to close care gaps while maintaining HIPAA.