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

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Job Information
Humana
RN - Senior STARS Improvement Professional - Treasure Coast and Brevard County area
in
Port Saint Lucie
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
We will require full COVID vaccination (**** for this job as 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 documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.
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 75% of time visiting provider offices in the Treasure Coast / Brevard area
Scheduled Weekly Hours
40

Company info

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