Consultant supporting execution of consulting engagements across multiple industries in Transaction Advisory Services. Active participation in project management and client relationship management.
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
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