Clinical Care RN: Transitions & Quality Leader

Humana Inc; Biloxi (MS); On-site; USD 64,000 - 88,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Disability insurance

Life insurance

Job summary

Humana Inc. is seeking a Clinical Care Nurse (RN) to support clinic-based transitions of care, reduce avoidable ED utilization, and enhance Medicare Advantage Stars and quality performance.

The role involves analyzing data, coordinating post-discharge follow-ups, and educating patients across DM, HTN, CHF, and COPD. You will work in designated Mississippi clinic sites, including Biloxi and Gulfport, with daily in-center responsibilities.

Qualifications

• Must have ADN or BSN.
• Active, unrestricted RN license in Mississippi.
• 3+ years nursing experience with transitions of care, quality improvement, managed care, or population health.
• Proficient with Athena EMR, DataHub, Compass Rose, Salesforce HealthCloud, and MS Office.
• Basic Life Support (BLS) certification required.
• Preferred: Medicare Advantage Stars, HEDIS, CMS quality requirements.
• Experience with Transitions of Care, discharge, or ER follow-up programs.
• Strong clinical judgment and data analysis skills.
• Excellent communication and motivational interviewing.

Responsibilities

• Analyze clinical data and trends to identify gaps in Stars and HEDIS measures.
• Coordinate timely post-discharge follow-up for TOC and TCM requirements.
• Conduct outreach via phone, telehealth, and in-clinic visits for education and care opportunities.
• Assess discharge instructions, reconcile medications, and ensure follow-up adherence.
• Collaborate with providers and care team to prevent readmissions.
• Work with interdisciplinary teams to implement evidence-based interventions.
• Document outreach and outcomes per CMS and organizational standards.
• Participate in center huddles and high-risk rounds with the care team.
• Support quality improvement projects and provider education activities.
• Monitor Stars and transitional care goals; identify barriers and solutions.
• Assist with clinic operations, care coordination, and community education.

Skills

Athena EMR

DataHub

Compass Rose

SalesForce HealthCloud

Microsoft Office

Education

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

Job description

Humana Inc. is seeking a Clinical Care Nurse (RN) to support clinic-based transitions of care, reduce avoidable ED utilization, and enhance Medicare Advantage Stars and quality performance.

The role involves analyzing data, coordinating post-discharge follow-ups, and educating patients across DM, HTN, CHF, and COPD. You will work in designated Mississippi clinic sites, including Biloxi and Gulfport, with daily in-center responsibilities.