The Stars Improvement, Clinical Professional 2 responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Stars Improvement, Clinical Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Stars Improvement Clinical Professional (RN) collaborates with market leadership, and quality improvement team to develop and implement programs designed to increase patient outcomes. Work is performed within the associate's assigned center locations and in collaboration with existing Quality Improvement Coordinators and Professionals and in close partnership with market and center teams.
The Stars Improvement, Clinical Professional (RN) represents the scope of provider relationships across the following areas:
- Quality/clinical management and population health
- HEDIS and Stars performance
- Operational improvements
- Financial performance and incentive programs
- Data sharing and connectivity
- Documentation and coding
- Additional areas related to provider performance, member experience, market growth, provider experience and operational excellence
Use your skills to make an impact Required Qualifications- Registered Nurse with 2 years of experience of in home case/care management
- Experience working with the adult population
- Knowledge of community health and social service agencies and additional community resources
- Ability to travel to member's residence within 30 to 40 miles
- Exceptional communication and interpersonal skills with the ability to quickly build rapport
- Ability to work with minimal supervision within the role and scope
- Ability to use a variety of electronic information applications/software programs including electronic medical records
- Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel
- Excellent keyboard and web navigation skills
- Ability to work a full-time (40 hours minimum) flexible work schedule
- 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 to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their 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
- Must have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you work
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana At Home systems if 5Mx1M
- This role is considered patient facing and is part of Humana At Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
- Valid driver's license, car insurance, and access to an automobile
- Associates working in the State of Florida will need ACHA Level II Background clearance
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications- BSN
- 3-5 years of in home assessment and care coordination experience
- Experience with health promotion, coaching and wellness
- Previous managed care experience
- Bilingual - English, Spanish
- Certification in Case Management
- Motivational Interviewing Certification and/or knowledge
Additional InformationScheduled Weekly Hours40
Pay RangeThe 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 BenefitsHumana, 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, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
