RN Senior STARS Improvement Professional - South Florida Treasure Coast and Brevard County area

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Job Information

Humana

RN Senior STARS Improvement Professional - South Florida, Treasure Coast and Brevard County area

in

Jupiter

Florida

Description

The Senior STARS Improvement Professional develops, implements, and manages oversight of the company's Medicare/Medicaid Stars Program. Directs all Stars quality improvement programs and initiatives. The Senior STARS Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Stars Improvement Professional will facilitate and work collaboratively with provider groups focused on Medicare plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality and patient experience.

Effectively develop, enhance and maintain provider clinical relationship

Prepare, analyze and present provider/member-specific metrics surrounding clinical and patient experience measures through market reporting. Coach providers on gap closing opportunities for Humana members

Accurately define gaps in Humana's service relationship with providers and facilitate resolution

Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support

Review medical records and identify needed improvements that impact HEDIS or Star measures or coding

Effectively coach provider office staff on best means to communicate with Senior members that may have hearing, vision, and physical challenges

Work collaboratively with Humana's internal departments locally and nationally in support of providers and groups

Understands department, segment and business operating objectives, including their linkages to Stars

Makes decisions regarding own work methods, occasionally in ambiguous situations; is able to conduct daily

Required Qualifications

An active Registered Nurse (RN) License in Florida

5 or more years of clinical experience

Strong attention to detail and focus on process and quality

Strong verbal and written communication skills

Ability to operate under tight deadlines

Proven organizational and prioritization skills and ability to collaborate with multiple departments

Comprehensive knowledge of all Microsoft Office applications, including Access, Excel and Outlook

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.If progressed to offer, you will be required to:* Provide proof of full vaccination or commit to testing protocols

*OR  *

* Provide proof of applicable exemption including any required supporting documentation

Preferred Qualifications

Bachelor's Degree in Business, Finance, Health Care or a related field

Progressive experience in the health solutions industry

Prior managed care experience

Prior Medicare/Medicaid experience

Understanding of metrics, trends and the ability to identify gaps in care

Understanding of CMS Stars, performance measures, HEDIS knowledge and experience a plus

Background working in quality improvements

Coding experience a plus

Additional Information

This is currently a Work at Home/virtual position however when travel is allowed this position will be in field visiting provider offices in the Treasure Coast / Brevard area

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com