Quality RN - North Charleston SC

Humana; North Charleston (SC); On-site; USD 71,100 - 97,800; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401(k) retirement savings plan

Paid time off and holidays

Short-term and long-term disability

Life insurance

Job summary

A healthcare company in North Charleston, SC is seeking a Quality RN to oversee the Medicare/Medicaid Stars Program. The ideal candidate possesses a valid RN license and at least 5 years of clinical experience. Responsibilities include collaborating with teams to enhance patient outcomes. Competitive salary range is $71,100 - $97,800 annually, with additional benefits offered.

Qualifications

• Licensed Registered Nurse (RN) without restriction in the applicable state.
• 5+ years of clinical nursing experience.
• Proven work experience as a HEDIS Nurse or similar role.
• Strong interpersonal and communication skills.

Responsibilities

• Responsible for the development and management of the Stars Program.
• Collaborate with leadership and quality teams to improve patient outcomes.
• Represent the scope of provider relationships across various areas.

Skills

Clinical nursing experience

Knowledge of HEDIS/Stars/CMS

Presentation and communication skills

Relationship building skills

Attention to detail

Microsoft Office applications

Education

Registered Nurse (RN) license

Bachelor’s degree in Nursing

Job description

Quality RN - North Charleston SC

Humana

Become a part of our caring community and help us put health first

The Quality RN Professional is responsible for the development, implementation, and management oversight of Humana’s Medicare/Medicaid Stars Program. The role involves varied assignments that often require independent interpretation of the appropriate courses of action.

The Quality RN Professional collaborates with market leadership and the quality improvement team to develop and implement programs designed to increase patient outcomes. Work is performed within the assigned center locations and in collaboration with Quality Improvement Coordinators, other Professionals, and market and center teams.

The Quality RN Professional represents the scope of provider relationships across the following areas:

• 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

Use your skills to make an impact

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in the applicable state
• 5+ years of clinical nursing experience
• Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement
• Strong knowledge of HEDIS/Stars/CMS
• 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
• Comprehensive knowledge of Microsoft Office applications

Preferred Qualifications

• Bachelor’s degree in Nursing
• 3+ years of managed care experience
• 3+ years of case management experience
• Bilingual; English and Spanish preferred, not required

Additional Information

• Hours: Monday‑Friday 8:00 AM–5:00 PM local time zone
• This role is based within the provider office with regular rotation through each center within the assigned territory.
• This role is part of Humana’s Tuberculosis (TB) screening program. If selected, you will be required to be screened for TB.
• This role is part of CenterWell’s driver safety program and therefore requires a valid state driver’s license. The individual is expected to maintain personal vehicle liability insurance as required by the residing state or the higher of $25,000 bodily injury per person / $25,000 bodily injury per event / $10,000 property damage.

Scheduled Weekly Hours 40

Pay Range

The compensation range reflects a good faith estimate of the starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 per year. This position is eligible for a bonus incentive plan based on company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliates offer competitive benefits that support whole-person well-being. Associate benefits encourage personal wellness and smart healthcare decisions for you and your family while recognizing that life extends beyond work. Benefits include medical, dental, and vision coverage; a 401(k) retirement savings plan; paid time off, company and personal holidays, and volunteer time off; paid parental and caregiver leave; short-term and long-term disability; life insurance; and many other opportunities.

About Us

CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment, and more. The unique care model focuses on personalized experiences, listening, learning, and addressing factors that impact patient well‑being. Integrated care teams spend up to 50% more time with patients, offering compassionate, personalized care that yields better health outcomes. The approach also addresses emotional and social wellness.

CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell focuses on whole-person health by addressing physical, emotional, and social wellness. CenterWell offers stability, industry-leading benefits, and career growth opportunities within Humana Inc. (NYSE: HUM). With over 30,000 clinicians committed to putting health first, CenterWell supports employees' personal and professional well‑being from day one through flexible scheduling, certifications, leadership development, and career coaching.

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. Humana also takes affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and advance individuals with disabilities or protected veteran status, basing all employment decisions on valid job requirements. This policy applies to all employment actions, including recruitment, hiring, promotion, transfer, demotion, layoff, recall, termination, compensation, training, and apprenticeship at all levels.