Remote Senior Stars Improvement, Clinical Professional (RN), Multiple Locations

Humana

Apply Now

Location: NC
Location Type: Remote
Additional Location: GA; SC; VA;
Schedule: Full_time
Req: R-326477

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

The Senior Stars Improvement, Clinical Professional (RN) is responsible for the development, implementation and management oversight of the company’s Medicare Stars Program in the SouthEast region. The Senior Stars Improvement, Clinical Professional (RN) work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

               

The Senior Stars Improvement Clinical Professional (RN) develops programs designed to increase the plan quality. Partners with leaders regarding implementation planning. Reviews and communicates results of programs. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

 

The Senior Stars Improvement, Clinical Professional (RN) represents the scope of health plan/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

 

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

  • Medical Benefits
  • Dental Benefits
  • Vision Benefits
  • Health Savings Accounts
  • Flex Spending Accounts
  • Life Insurance
  • 401(k)
  • PTO including 8 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
  • And more

Use your skills to make an impact

Required Qualifications

  • Licensed Registered Nurse (RN) without restriction in applicable state
  • 5+ years of clinical nursing experience
  • 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 30% within the region

Preferred Qualification

  • Bachelor’s degree in Nursing
  • 3+ years of managed care experience
  • 3+ years of case management experience
  • Strong knowledge of HEDIS/Stars/CMS

Additional Information

  • Hours for the role are: Monday-Friday 8am-5pm EST
  • This role is currently remote/virtual but candidate may travel to provider offices within region up to 30% in the near future

Work at Home/Remote Requirements

Work-At-Home Requirements

  • To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
    • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
    • Wireless, Wired Cable or DSL connection is suggested.
    • Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership.  (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
    • Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota.  Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
    • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
    • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

 

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire.  Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

 

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview.  Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

 

This is a remote position.

 

#LI-LM1

 

Scheduled Weekly Hours

 

40

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

 

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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.