Unknown Company is hiring a Senior Stars Clinical Consultant RN

Humana, a healthcare company committed to putting health first, is hiring a Senior Stars Clinical Consultant RN. You will be responsible for the development, implementation, and management oversight of the company's Medicare Stars Program in the Florida region. This is a hybrid position requiring onsite provider visits up to 40% of the time.

What You'll Do

• Develop programs designed to increase plan quality.
• Conduct medical records reviews and provide EMR remote provider gap closure support (30% of role).
• Participate in Stars new pilot strategies to support Humana provider specific measure care gap closure (30% of role).
• Conduct provider in person visits (40% of role).
• Partner with leaders regarding implementation planning and review and communicate results of programs.
• Analyze provider non-standard supplemental data trending.
• Conduct provider level HEDIS in-service.
• Develop and implement measure specific strategies.
• Conduct provider and member outreach on focused care gap measures.
• Implement EMR remote strategy for Humana provider care gap closure on targeted measures.
• Conduct provider office in person, Zoom virtual or telephonic meetings.
• Perform weekly metrics for provider outreach, which may include cold calling to in-network providers to establish working relationships.
• Focus on quality/clinical management and population health, HEDIS and Stars performance, operational improvements, financial performance and incentive programs, data sharing and connectivity, interoperability opportunities, and documentation and coding.

What We're Looking For

• Licensed Registered Nurse (RN) without restriction in Florida.
• 5 or more years of clinical nursing experience.
• 1 or more years of experience in electronic medical records systems and Medical Records auditing experience, in the past 5 years.
• 1 or more years of provider office and/or clinic management experience, in the past 5 years.
• 1 or more years experience visiting providers or members.
• Comprehensive knowledge of Microsoft Office applications, Word and Excel with advanced knowledge of PowerPoint.
• 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.
• Valid driver's license with reliable transportation and the ability to travel up to 40% within the region.

Nice to Have

• Bachelor’s degree in Nursing.
• 3 or more years of managed care experience.
• 3 or more years of case management experience.
• Working knowledge of HEDIS/Stars/CMS.

Technical Stack

• Microsoft Office (Word, Excel, PowerPoint)
• Electronic Medical Records (EMR) systems

Benefits & Compensation

• Compensation: $78,400 - $107,800 per year
• 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.
• Bonus incentive plan based upon company and/or individual performance.

Work Mode

This is a hybrid position requiring onsite provider visits up to 40% of the time. The role serves the Florida region (Central and North Florida, excluding South Florida and the Panhandle; far north limit Jacksonville). Ideal candidates are based in Gainesville or Ocala.

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.