RN Clinical Care Nurse - Transitions & Quality

humana; Las Vegas (NV); On-site; USD 80,000 - 110,000; Full time

Job summary

Humana is seeking a Clinical Care RN (RN) to support Transitions of Care and improve Medicare Advantage Stars and quality performance in a clinic setting in Las Vegas, NV. The role emphasizes post-discharge follow-up, patient education, and data-driven improvement.

You'll work with cross-functional teams, utilize Athena EMR and DataHub, and contribute to culturally competent care, HIPAA compliance, and health equity.

Qualifications

• ADN or BSN required.
• Active, unrestricted RN license (state-specific).
• 3+ years of clinical nursing experience with exposure to transitions of care, quality improvement, managed care, or population health management.
• Proficiency with electronic health records and data analytics tools.
• Willing to complete and maintain Basic Life Support training.

Responsibilities

• Analyze clinical data and trends to identify gaps related to Stars and HEDIS measures and TOC.
• Coordinate post-discharge follow-up for discharged patients per TOC/TCM requirements.
• Conduct targeted outreach via phone, telehealth, and in-clinic visits to close care opportunities.
• Educate patients on preventive care, chronic disease management, and medication management.
• Collaborate with interdisciplinary teams to implement interventions and optimize workflows.
• Document outreach efforts and outcomes in compliance with CMS standards.
• Participate in center huddles and high-risk rounds with providers.

Skills

Clinical nursing

Patient education

Communication

Data interpretation

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 RN (RN) to support Transitions of Care and improve Medicare Advantage Stars and quality performance in a clinic setting in Las Vegas, NV. The role emphasizes post-discharge follow-up, patient education, and data-driven improvement.

You'll work with cross-functional teams, utilize Athena EMR and DataHub, and contribute to culturally competent care, HIPAA compliance, and health equity.