Senior STARS Improvement, Clinical Professional

Humana; Florida; A distancia; USD 78.000 - 108.000; Jornada completa

Descripción de la vacante

Humana is seeking a Senior Stars Improvement, Clinical Professional in Florida to influence department strategy and decisions on moderately complex clinical initiatives. The role demands collaboration with cross-functional teams and a focus on quality metrics.

You will actively engage providers during virtual visits to drive HEDIS outcomes, educate on Medicaid CAHPS initiatives, and support performance improvement for assigned providers. Travel may be required for training and meetings.

Formación

• RN license in Florida
• Bachelor's degree in nursing
• Experience with Medicare/Medicaid or dual eligible populations
• Prior experience in a fast-paced insurance or health care setting
• Understanding of healthcare quality measures STARS, HEDIS, etc.
• Experience collaborating with cross-functional teams
• Proficiency in Microsoft Word, Excel and PowerPoint
• Proven analytical skills
• Excellent communication skills, both oral and written

Responsabilidades

• Continue to focus efforts and identify opportunities on performance improvement for assigned providers
• Actively engages provider during virtual visit to facilitate education, HEDIS outcomes, care of members and bi-directional feedback
• Attends JOCs with providers and participates in active discussions on HEDIS, member care, and clinical/quality outcomes
• Communicate clinical quality initiatives to assigned providers
• Educate and assist providers in reducing potential preventable events
• Educate providers and staff about Medicaid CAHPS survey

Conocimientos

FL RN License

Florida Residency

Nursing Degree

Medicare/Medicaid experience

Insurance/Healthcare experience

Cross-functional collaboration

MS Office

Educación

Bachelor's degree in nursing

Herramientas

Word

Excel

PowerPoint

Descripción del empleo

Become a part of our caring community

The Senior Stars Improvement, Clinical Professional This work focuses on areas of clinical emphasis. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

The Senior Stars Improvement, Clinical Professional This work focuses on areas of clinical emphasis. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

• Continue to focus efforts and identify opportunities on performance improvement for assigned providers
• Actively engages provider during virtual visit to facilitate education, HEDIS outcomes, care of members and bi-directional feedback.
• Attends JOCs with providers and participates in active discussions on HEDIS, member care, and clinical/quality outcomes.
• Communicate clinical quality initiatives to assigned providers
• Educate and assist providers in reducing potential preventable events
• Educate providers and staff about Medicaid Consume Assessment of Healthcare Providers and Systems (CAHPS) survey.

Required Qualifications

• FL RN License
• Must reside in the state of Florida
• Bachelor's degree in nursing
• Experience with Medicare, Medicaid, or dual eligible populations
• Prior experience in a fast-paced insurance or health care setting
• Understanding of healthcare quality measures STARS, HEDIS, etc.
• Experience collaborating with cross-functional teams
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
• Proven analytical skills
• Excellent communication skills, both oral and written

Preferred Qualifications

Use your skills to make an impact

• Medical Coding Certification
• Knowledge of Humana's internal policies, procedures, and systems
• Medicaid Health Plan Experience

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of 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.

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.