Quality RN Professional - Royal Palm

Become a part of our caring community and help us put health first

The Stars Improvement, Clinical Professional (RN) is responsible for the development, implementation and management oversight of the Primary Care Organization’s Stars Program in the South Florida market. The Stars Improvement, Clinical Professional (RN) works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Stars Improvement Clinical Professional (RN):

Collaborates with market leadership, and quality improvement team to develop and implement programs designed to increase the 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

Licensed Registered Nurse (RN) without restriction in Florida

5+ years of clinical nursing experience

Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement

Strong knowledge of HEDIS/Stars/CMS

Excellent presentation and communication skills, both oral and written

Strong relationship building skills as this is a provider-facing role

Strong attention to detail with a focus on process and quality

Comprehensive knowledge of Microsoft Office applications

Preferred Qualification

Bachelor’s Degree in Nursing

3+ years of managed care experience

3+ years of case management experience Bilingual; English and Spanish or Creole preferred, not required

Additional Information

Hours for the role are: Monday-Friday 8am-5pm local time zone

This role is based within the provider office with regular rotation through each center within the assigned territory.

Driver's License, Reliable Transportation, Insurance This role is part of Humana's Driver safety program and therefore requires an individual to have:

a valid state driver's license,

carry insurance in accordance with the state minimum required limits, or $25,000/$25,000/10,000 whichever is higher

and a reliable vehicle.

Tuberculosis (TB) screening: This role is considered member 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.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours

40

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.

About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.