RN Senior Stars Improvement Clinical Professional

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Job Information

Humana

RN, Senior Stars Improvement, Clinical Professional

in

Vancouver

Washington

Description

Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will be responsible for the development, implementation, and management oversight of the company's Medicaid Stars Program. The Senior Stars Improvement, Clinical Professional works on assignments that involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The RN, Senior Stars Improvement, Clinical Professional focuses on areas of clinical emphasis. They make decisions on issues regarding technical approach for project components, and their work is performed without direction. The RN, Senior Stars Improvement, Clinical Professional exercises considerable latitude in determining objectives and approaches to assignments.

Responsibilities

Reviews provider and member-specific UM and QI metrics to coach assigned providers, providers groups and/or MSO groups on gap closing opportunities.

Drives improvement of quality outcomes for providers through in-person, virtual, telephone, email and/or JOC meeting.

Provides resources and educational opportunities to assigned providers and staff.

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

Reviews medical records or claims to identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture and provide guidance to practice).

Prepares quality slide and presents quality, UM, and CM slides at JOC meeting.

Educates providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.

Prepares and compiles HEDIS reports for distribution to providers.

Required Qualifications

An active unrestricted Registered Nurse (RN) license in the state of Florida.

3 years of clinical experience.

Strong knowledge of HEDIS, STARS, Medicaid and/or Medicare Quality.

Intermediate to advanced proficiency in Microsoft Office programs specifically, Excel, Word, and PowerPoint.

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

Strong organizational and prioritization skills with ability to collaborate with multiple departments.

Detail orientated and comfortable working with tight deadlines in a fast-paced environment.

Ability to work independently under general instructions, self-directed and motivated.

Excellent written and oral communication skills.

Work at Home/Remote Requirements

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

Bachelor's Degree in Business Administration, Health Administration, or a related field.

Progressive experience in the health solutions industry.

Prior managed care experience.

Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus.

Coding experience a plus.

Preferably residing in the state of Florida but not required.

Additional Information

Workstyle:

Remote, US

Workdays and Hours:

Monday - Friday; 40-hour work schedule. Leadership will discuss further in interview.

Travel:

Possible occasional travel to provider offices and team engagement meetings in the state in Florida.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Social Security Task

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

#LI-Remote

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

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