[Hiring] Senior STARS Improvement, Clinical Professional @Humana

Role Description

Become a part of our caring community as a Senior Stars Improvement, Clinical Professional. This work focuses on areas of clinical emphasis and begins to influence the 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 visits 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 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

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

Requirements

• To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service 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.
• Occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Competitive benefits that support whole-person well-being.
• 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.

Company Description

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.