Senior Stars Improvement, Clinical Professional at Humana

Clearwater, Florida, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, MedicareIndustries

Requirements

Licensed Registered Nurse (RN) without restriction in applicable state
5+ years of clinical nursing experience
1+ years' experience in a fast-paced healthcare operational role, including hospital, provider or member facing nursing responsibilities
Experience in provider engagement and relationship management
Strong understanding of Stars measures and quality improvement initiatives
Proven ability to influence clinical practice or provider performance
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

Responsibilities

Development, implementation and management oversight of the company's Medicare Stars Program in the West Coast Tampa region (Clearwater, St. Petersburg, Palm Harbor, Dunedin)
Develops programs designed to increase the plan quality
Partners with leaders regarding implementation planning
Reviews and communicates results of programs
Represents the scope of health plan/provider relationships across provider facing Zoom virtual/telephonic meetings, quality/clinical management and population health, HEDIS and Stars performance, operational improvements, financial performance and incentive programs, data sharing and connectivity, documentation and coding, and additional areas related to provider performance, member experience, market growth, provider experience and operational excellence

Skills

Registered Nurse (RN)

Stars measures

HEDIS

Quality improvement

Provider engagement

Population health

Microsoft Excel

Microsoft PowerPoint

Presentation skills

Relationship building

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.

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