[Hiring] Senior STARS Improvement, Clinical Professional @Humana

Role Description

The Senior Stars Improvement, Clinical Professional 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

• Medical Coding Certification (Preferred)
• Knowledge of Humana's internal policies, procedures, and systems (Preferred)
• Medicaid Health Plan Experience (Preferred)
• Work at Home Requirements:
  • Minimum download speed of 25 Mbps and upload speed of 10 Mbps is required.
  • Wireless, wired cable, or DSL connection is suggested.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Competitive 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
• Many other opportunities to support whole-person well-being

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 based on company and/or individual performance.