Clinical Care RN: Transitions & Quality Champion

Humana Inc; Palm Coast (FL); On-site; USD 71,000 - 98,000; Full time

Job summary

Humana Inc. through Conviva Senior Primary Care seeks a Clinical Care Nurse (RN) to support transitions of care and improve Medicare Advantage quality metrics. This clinic-based role emphasizes patient education, timely follow-up, and proactive care coordination in Palm Coast, FL.

You will collaborate with providers and care teams, analyze data from EMR and reporting tools, and participate in quality improvement projects to reduce readmissions and enhance patient outcomes and satisfaction.

Qualifications

• Associate's degree in nursing (ADN) or Bachelor's in nursing (BSN).
• Active, unrestricted RN license in Florida.
• 3+ years' clinical nursing experience with TOC, quality improvement, managed care, or population health.
• Proficiency with electronic health records (e.g., Athena EMR), data analytics tools (DataHub, Compass Rose, Salesforce HealthCloud) and MS Office.
• Willing and able to complete and maintain Basic Life Support.

Responsibilities

• Analyze clinical data and trends to identify gaps in care related to Stars and HEDIS measures.
• Identify recently discharged patients and coordinate timely post-discharge follow-up per TOC/TCM.
• Conduct targeted outreach via phone, telehealth, and in-clinic visits to close care gaps.
• Provide education on preventive care, chronic disease management, and medication management.
• Monitor discharge instructions comprehension, medication reconciliation, and appointment adherence.
• Collaborate with providers, care team, etc., to prevent readmissions and AED utilization.
• Document outreach, interactions, and outcomes accurately in CMS/compliant systems.

Skills

Nursing

TOC coordination

Data analysis

EHR systems

Education

ADN/BSN

Tools

Athena EMR

DataHub

Compass Rose

Salesforce HealthCloud

MS Office

Job description

Humana Inc. through Conviva Senior Primary Care seeks a Clinical Care Nurse (RN) to support transitions of care and improve Medicare Advantage quality metrics. This clinic-based role emphasizes patient education, timely follow-up, and proactive care coordination in Palm Coast, FL.

You will collaborate with providers and care teams, analyze data from EMR and reporting tools, and participate in quality improvement projects to reduce readmissions and enhance patient outcomes and satisfaction.