Clinical Care RN: Transitions & Quality Improvement

humana; Decatur (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

Humana is seeking a Clinical Care Nurse (RN) to strengthen transitions of care and improve patient outcomes in a clinic setting. You will drive Medicare Advantage Stars and quality performance, while balancing patient education with data-driven quality improvement efforts.

You will analyze data, identify care opportunities, and coordinate post-discharge follow-ups to prevent readmissions. Collaboration with providers and care teams is essential.

Qualifications

• Must hold ADN or BSN in nursing (one of them).
• Active, unrestricted RN license (state-specific).
• 3+ years' clinical nursing experience with TOC, quality improvement, or population health exposure.
• Proficient with Athena EMR and data analytics tools (DataHub, Compass Rose, Salesforce HealthCloud) and MS Office.
• Willing to complete and maintain Basic Life Support training.

Responsibilities

• Analyze clinical data from platforms like Athena EMR and DataHub 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 requirements.
• Conduct outreach via phone, telehealth, and in-clinic visits to close care opportunities and educate on preventive care.
• Assess discharge instructions, reconcile meds, monitor symptoms, and ensure follow-up appointment adherence.
• Collaborate with providers, care team, and quality improvement staff to implement interventions and optimize workflows.

Skills

Data analysis

Communication skills

Motivational interviewing

Clinical judgment

Education

Associate's degree in nursing (ADN)

Bachelor's degree in nursing (BSN)

Tools

Athena EMR

DataHub

Compass Rose

Salesforce HealthCloud

Microsoft Office Suite

Job description

Humana is seeking a Clinical Care Nurse (RN) to strengthen transitions of care and improve patient outcomes in a clinic setting. You will drive Medicare Advantage Stars and quality performance, while balancing patient education with data-driven quality improvement efforts.

You will analyze data, identify care opportunities, and coordinate post-discharge follow-ups to prevent readmissions. Collaboration with providers and care teams is essential.