Senior Stars Clinical Consultant RN

Become a part of our caring community
 The Senior Stars Clinical Consultant (RN) is responsible for the implementation and management oversight of the company's Medicare Stars Program in the Florida region. The Senior Stars Clinical Professional (RN) develops programs designed to increase the plan quality. Partners with leaders regarding the implementation of Stars gap closure campaigns. You will report to the Associate Director.

Key Responsibilities

• Lead measure-specific Medicare Stars gap closure campaigns to improve quality performance outcomes
• Conduct medical record reviews, support EMR-based provider gap closure and perform member telephonic outreach
• Engage providers through in-person visits traveling up to 30%, virtual meetings, and phone outreach to build relationships and support care gap closure
• Partner with measure leaders, program leads, vendors, and internal teams to execute Stars initiatives and pilot strategies
• Provide clinical expertise and support provider education, including HEDIS in-service discussions and quality improvement opportunities
• Identify opportunities to improve documentation, coding, supplemental data, interoperability, provider performance, member experience, and operational excellence
• Apply Stars operations knowledge, technical specifications, value sets, coding, and HEDIS gap closure processes to support strategic decision-making

Use your skills to make an impact
 

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in Florida
• Valid driver's license with reliable transportation and the ability to travel up to 30% within the State of Florida
• 5+ years of clinical nursing experience
• 1+ years' electronic medical records systems and Medical Records auditing experience, in the past 5 years
• 1+ years' provider office and/or clinic management experience, in the past 5 years
• Experience visiting providers
• Presentation experience using PowerPoint
• Knowledge of Microsoft Office applications, Word and Excel

Preferred Qualifications

• Bachelor's degree in nursing
• 3+ years of managed care experience
• 3+ years of case management experience
• Working knowledge of HEDIS/Stars/CMS

Additional Information

• Hours for the role are Monday-Friday 8am-5pm EST
• This role is remote/virtual, but candidates may travel to provider offices within the state of Florida up to 30% and travel to Tampa or South Florida Humana market offices within region for in person meetings

Driving Statement

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher

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 at Humana.com and at CenterWell.com.

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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.