Senior Stars Clinical Consultant RN at Humana

Gainesville, Florida, United States

Apply Now

Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, MedicareIndustries

Requirements

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
Based in Gainesville or Ocala (Central and North Florida areas, exclude South Florida area and Panhandle; far north Florida limit would be Jacksonville)

Responsibilities

Development, implementation and management oversight of the company's Medicare Stars Program in the Florida region
Develop programs designed to increase the plan quality
Medical records reviews and EMR remote provider gap closure support (30% of role)
Participate in Stars new pilot strategies that support Humana provider specific measure care gap closure (30% of role)
Provider in-person visits (40% of role)
Partner with leaders regarding implementation planning
Review and communicate results of programs
Provider non-standard supplemental data trending
Provider level HEDIS in-service
Develop and implement measure specific strategies
Provider and Member outreach on focused care gap measures
EMR remote strategy for Humana provider care gap closure on targeted measures
Provider office in-person, Zoom virtual or telephonic meetings
Weekly metrics for provider outreach (may apply; some Zoom telephonic outreach will entail cold calling to in-network providers to establish working relationships)
Quality/clinical management and population health
HEDIS and Stars performance
Operational improvements
Financial performance and incentive programs
Data sharing and connectivity, interoperability opportunities
Documentation and coding
Additional areas related to provider performance, member experience, market growth, provider experience and operational excellence

Skills

Medicare Stars

HEDIS

Medical Records Review

EMR

Provider Outreach

Quality Management

Population Health

Stars Performance

HEDIS In-Service

Documentation and Coding

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

Land your dream remote job 3x faster with AI

Try Jobo Free