Become a part of our caring community
The Clinical Care Nurse (RN) is a clinic-based nursing role focused on improving patient outcomes. You will support safe Transitions of Care (TOC), reduce avoidable ED utilization, and drive Medicare Advantage Stars and quality performance. The Clinical Care RN plays a critical role in advancing clinical quality and supporting patients across transitions of care to improve patient outcomes.
Location: Orlando (West Orange)
As a Clinical Care RN, you will contribute to Medicare Advantage Stars ratings by proactively identifying care opportunities, engaging patients and providers, and driving evidence-based interventions. You will balance direct patient education and outreach with data-driven quality improvement efforts. The Clinical Care RN aligns daily responsibilities with organizational values, integrity, respect, empathy, and commitment to health equity – to enhance patient health outcomes and satisfaction.
Transitions:Caretransition support, follow-up coordination, and avoidable readmission prevention for discharged inpatient, observationand emergency department patients.
Population Health: Deliver culturallyappropriate chronicdisease education to activate patients are chronic disease self-management, particularly in DM, HTN, CHF and COPD.
Duties and Responsibilities:
Proactivelyidentifyrecently discharged inpatient, observation and emergency department patients and coordinate timelypost-discharge follow-up in alignment with TOC and Transitional Care Management (TCM) requirements, with the aim of addressing root causes of utilizationand supporting patients to prevent avoidable readmissions or return visits.
Conduct targeted patient and provider outreach via phone, telehealth and in-clinic visits to close care opportunities, provide tailored education on preventive care, chronic disease management, and medication management.
Conduct post-discharge outreach to assess understanding of discharge instructions, bottles-out medication reconciliation, symptom monitoring, and follow-up appointment adherence.Identifyand escalate barriers, collaborating with providers and care teamto prevent readmissions and avoidable ED utilization.
Collaborate effectively with interdisciplinaryteams,including providers, care assistants, center administrators, medical assistants, pharmacy, and quality improvement staff—to implement evidence-based interventions andoptimizeworkflows.
Use your skills to make an impact
3+ years' clinical nursing experience with exposure to transitions of care, quality improvement, managed care, or population health management.
Proficiencywith electronic health records (e.g., Athena EMR), data analytics tools (e.g.,DataHub, Compass Rose,SalesForceHealthCloud – per your prior employer’s population health tools), and Microsoft Office Suite.
Preferred Qualifications:
Experience with Transitions of Care, hospital discharge or ERfollow upprograms.
Bilingual in English and Spanish with full professionalproficiency.
Values & Mission Alignment:
This role requires an in-center presence, involving daily commute to assigned clinic(s) and occasional (quarterly) travel within the market to alternative clinic(s) for strategic meetings.
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected tomaintainpersonal vehicle liability insurance. Individualmust carry vehicle insurance in accordance withtheir residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
Scheduled Weekly Hours
40
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.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits,
