Senior Stars Clinical Consultant RN

The Senior Stars Clinical Consultant (RN) is responsible for the implementation and management oversight of the company's Medicare Stars Program in the Florida region. The Senior Stars Clinical Professional (RN) develops programs designed to increase the plan quality. Partners with leaders regarding the implementation of Stars gap closure campaigns. You will report to the Associate Director.

Key Responsibilities

• Lead measure-specific Medicare Stars gap closure campaigns to improve quality performance outcomes
• Conduct medical record reviews, support EMR-based provider gap closure and perform member telephonic outreach
• Engage providers through in-person visits traveling up to 30%, virtual meetings, and phone outreach to build relationships and support care gap closure
• Partner with measure leaders, program leads, vendors, and internal teams to execute Stars initiatives and pilot strategies
• Provide clinical expertise and support provider education, including HEDIS in-service discussions and quality improvement opportunities
• Identify opportunities to improve documentation, coding, supplemental data, interoperability, provider performance, member experience, and operational excellence
• Apply Stars operations knowledge, technical specifications, value sets, coding, and HEDIS gap closure processes to support strategic decision-making

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in Florida
• Valid driver's license with reliable transportation and the ability to travel up to 30% within the State of Florida
• 5+ years of clinical nursing experience
• 1+ years' electronic medical records systems and Medical Records auditing experience, in the past 5 years
• 1+ years' provider office and/or clinic management experience, in the past 5 years
• Experience visiting providers
• Presentation experience using PowerPoint
• Knowledge of Microsoft Office applications, Word and Excel

Preferred Qualifications

• Bachelor's degree in nursing
• 3+ years of managed care experience
• 3+ years of case management experience
• Working knowledge of HEDIS/Stars/CMS

Additional Information

• Hours for the role are Monday-Friday 8am-5pm EST
• This role is remote/virtual, but candidates may travel to provider offices within the state of Florida up to 30% and travel to Tampa or South Florida Humana market offices within region for in person meetings

Driving Statement

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

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.