Quality Improvement Senior Clinical Professional (RN)

Humana; Jupiter (FL); Remote; USD 78,000 - 108,000; Full time

Job summary

A leading healthcare organization in Jupiter, Florida seeks a Quality Improvement Senior Clinical Professional (RN) to manage the Medicare Stars Program. The role involves provider outreach, data management, and improving plan quality. Candidates must be licensed RNs with extensive nursing experience. This position currently offers remote work with occasional travel requirements. Competitive benefits package is included.

Benefits

Medical Benefits

Dental Benefits

Vision Benefits

401(k)

Paid Time Off

Qualifications

• Licensed Registered Nurse (RN) without restriction in applicable state.
• 5+ years of clinical nursing experience.
• Comprehensive knowledge of Microsoft Office applications.

Responsibilities

• Develop and manage the Medicare Stars Program.
• Conduct provider outreach and establish relationships.
• Review metrics and communicate results of programs.

Skills

Clinical nursing management

Provider relationship building

Presentation and communication skills

Attention to detail

Education

Bachelor’s degree in Nursing

Tools

Microsoft Office (Word, Excel, PowerPoint)

Job description

Quality Improvement Senior Clinical Professional (RN)

Pay $78,400 - $107,800 per year

Location: Jupiter/Florida

Employment type: Full-Time

Job Description

The Quality Improvement Senior Clinical Professional (RN) is responsible for the development, implementation, and management oversight of the company's Medicare Stars Program in the SouthEast Florida region (West Palm Beach, Stuart, Jupiter - Treasure Coast/Palm Beach Market).

The Quality Improvement Senior Clinical Professional (RN) develops programs designed to increase the plan quality. Partners with leaders regarding implementation planning. Reviews and communicates results of programs.

• Provider facing Zoom virtual/telephonic meetings
• Weekly metrics for provider outreach, some Zoom telephonic outreach will entail calling to the in-network providers to establish working relationships
• Quality/clinical management and population health
• HEDIS and Stars performance
• Operational improvements
• Financial performance and incentive programs
• Data sharing and connectivity
• Documentation and coding
• Additional areas related to provider performance, member experience, market growth, provider experience, and operational excellence

In addition to being a great place to work, Humana also offers industry-leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• Health Savings Accounts
• Flex Spending Accounts
• Life Insurance
• 401(k)
• PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
• And more

Use your skills to make an impact

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in applicable state
• 5+ years of clinical nursing experience
• Comprehensive knowledge of Microsoft Office applications, Word and Excel with advanced knowledge of PowerPoint
• Excellent presentation and communication skills, both oral and written
• Strong relationship building skills as this is a provider-facing role
• Strong attention to detail with a focus on process and quality
• Valid driver's license with reliable transportation and the ability to travel up to 30% within the region

Preferred Qualifications

• Bachelor’s degree in Nursing
• 3+ years of managed care experience
• 3+ years of case management experience
• Strong knowledge of HEDIS/Stars/CMS

Additional Information

• Hours for the role are: Monday-Friday 8am-5pm EST
• This role is currently remote/virtual but candidate may travel to provider offices within region up to 30% in the near future
• This position will be located in the West Palm Beach, Stuart, Jupiter - Treasure Coast/Palm Beach Market area.

Humana is an Equal Opportunity Employer. It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.