Clinical Care RN: Transitions & Quality Improvement

Humana Inc; Las Vegas (NV); On-site; USD 71,000 - 98,000; Full time

Job summary

Humana Inc. is seeking a Clinic-based Clinical Care RN (Nevada). The role focuses on transitions of care, post-discharge follow-up, and quality improvement to support Medicare Advantage Stars and overall patient outcomes.

Responsibilities include data analysis, outreach, education, and collaboration with providers to close care gaps. A Nevada RN license and ADN/BSN are required, with 3+ years in clinical nursing and TOC exposure.

Qualifications

• Must have ADN or BSN.
• Active, unrestricted RN license in Nevada.
• 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 and able to complete and maintain Basic Life Support training.

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.
• 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.
• Conduct targeted patient and provider outreach via phone, telehealth and in-clinic visits to educate on preventive care, chronic disease management, and medication management.
• Conduct post-discharge outreach to assess understanding of discharge instructions, medication reconciliation, symptom monitoring, and follow-up adherence.
• Collaborate with interdisciplinary teams to implement evidence-based interventions and optimize workflows.
• Document all outreach efforts, clinical interactions, and outcomes in compliance with CMS standards.
• Participate in center huddles, high-risk rounds, and quality improvement initiatives.
• Monitor progress toward Stars and TCM goals and develop solutions to improve performance and engagement.

Skills

RN clinical experience

EHR proficiency

Data analytics awareness

Microsoft Office

BLS certified

Education

Associate's degree in nursing (ADN) or Bachelor's degree in nursing (BSN)

Tools

Athena EMR

DataHub

Compass Rose

Salesforce HealthCloud

Microsoft Office Suite

Job description

Humana Inc. is seeking a Clinic-based Clinical Care RN (Nevada). The role focuses on transitions of care, post-discharge follow-up, and quality improvement to support Medicare Advantage Stars and overall patient outcomes.

Responsibilities include data analysis, outreach, education, and collaboration with providers to close care gaps. A Nevada RN license and ADN/BSN are required, with 3+ years in clinical nursing and TOC exposure.