Hybrid Senior Clinical Consultant, RN

at Humana

• Job title: Senior Clinical Consultant, RN
• Job type: Full Time
• Experience level: Senior
• Salary: $78,400 - $107,800 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Gainesville, United States

About the role

• Clinical Professional (RN) overseeing Medicare Stars Program in Florida. Responsible for program development, implementation and management, including provider visits and quality improvement strategies.

Responsibilities

• responsible for the development, implementation and management oversight of the company's Medicare Stars Program in the Florida region
• Develops programs designed to increase the plan quality
• Medical records reviews, EMR remote provider gap closure support will be 30% of role
• 30% of role is participating in Stars new pilot strategies that will support Humana provider specific measure care gap closure
• 40% will include provider in person visits
• Partners with leaders regarding implementation planning
• Reviews and communicates 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 the 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

Requirements

• Licensed Registered Nurse (RN) without restriction in Florida
• 5 or more years of clinical nursing experience
• 1 or more years of 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

Benefits

• 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 and many other opportunities