Senior STARS Improvement Clinical Professional RN - Work at Home MN WI IL or IA

Profile

Description

The Senior Stars Improvement, Clinical Professional is responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars program. The Senior Stars Improvement, Clinical 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, Clinical Professional's work focuses on areas of clinical emphasis. Begins to influence 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.

The Senior Stars Improvement Clinical Professional's work focuses on quality improvement programs. Influences provider group 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.

Effectively develop, enhance and maintain provider relationships

Facilitate virtual and in-person meetings with provider groups

Review and communicate to providers groups results of Humana Quality programs

Identify specific practice needs to provide support

Collaborate with internal and external stakeholders to improve regional quality performance

Provide support and consultation to provider groups related to CMS Stars programs as well as Humana's quality programs

Required Qualifications

An active Registered Nurse (RN) License free of restrictions

5 years of clinical, Quality or Stars experience

Prior Medicare/Medicaid experience

Strong attention to detail and focus on process and quality

Excellent presentation and communication skills, both oral & written

Strong relationship building skills

Ability to operate under tight deadlines

Ability to work closely with collaborative remote teams

Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, PowerPoint, Teams and Outlook

This role is considered provider facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you may be required to be screened for TB

Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

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

Understanding of CMS Stars program including HEDIS, CAHPS/HOS and Patient Safety

Background working in quality improvement

Progressive experience in the health solutions industry

Prior managed care experience

Understanding of metrics, trends and the ability to identify areas of opportunity

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

Coding experience

Additional Information

This is a work at home position and the ideal candidate must live in one of these states, Minnesota, Wisconsin, Illinois or Iowa.

Currently this position is not doing any traveling as we adhere to our company travel restriction policy due to COVID-19 .

As the Covid-19 environment changes and we return to normal business operations, this position will require travel to provider offices 10%-15% of the time.

Scheduled Weekly Hours

40

Company info

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