Clinical Care RN: Transitions & Quality Impact

Humana Inc; Thousand Oaks (CA); On-site; USD 71,000 - 98,000; Full time

Job summary

Humana Inc. seeks a Clinical Care Nurse (RN) for clinic-based care to support safe transitions of care and improve Medicare Advantage Stars. The role involves post-discharge follow-up, patient education, and data-driven quality activities across multiple teams.

You will work in-center to engage patients and providers, driving evidence-based interventions and ensuring regulatory compliance. The ideal candidate has an RN license, 3+ years of relevant experience, and proficiency with Athena EMR and

Qualifications

• Associate's degree in nursing (ADN) or Bachelor's degree in nursing (BSN).
• Active, unrestricted RN license in the State of Texas.
• 3+ years' 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 (e.g., DataHub, Compass Rose, Salesforce HealthCloud), and Microsoft Office Suite.
• Willing to complete and maintain Basic Life Support training.

Responsibilities

• Analyze clinical data and trends from platforms to identify gaps in care related to Stars and HEDIS measures.
• Coordinate timely post-discharge follow-up to address TOC needs and prevent readmissions.
• Conduct outreach via phone, telehealth, and in-clinic visits to educate on preventive care and disease management.
• Document outreach efforts and outcomes in compliance with CMS and organizational standards.
• Collaborate with interdisciplinary teams to implement interventions and optimize workflows.

Skills

RN with TOC experience

Quality improvement skills

Communication skills

Bilingual English/Spanish

Education

Associate's or Bachelor's degree in nursing

Tools

Athena EMR

DataHub

Compass Rose

Salesforce HealthCloud

Microsoft Office Suite

Job description

Humana Inc. seeks a Clinical Care Nurse (RN) for clinic-based care to support safe transitions of care and improve Medicare Advantage Stars. The role involves post-discharge follow-up, patient education, and data-driven quality activities across multiple teams.

You will work in-center to engage patients and providers, driving evidence-based interventions and ensuring regulatory compliance. The ideal candidate has an RN license, 3+ years of relevant experience, and proficiency with Athena EMR and