Colorado Jobs

Colorado Jobs

Job Information

Humana Senior STARS Improvement Clinical Professional (RN) - Denver Area (Work at Home) in Colorado Springs, Colorado

Description

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

Responsibilities

The Senior Stars Improvement, Clinical Professional's work focuses on areas of clinical emphasis. 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's work focuses on quality improvement programs. Influences provider group 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.

  • Facilitate virtual and in-person meetings with provider groups

  • Review and communicate to providers groups results of Humana Quality programs

  • Collaborate with internal and external stakeholders to improve regional quality performance

  • Provide support and consultation to provider groups related to CMS Stars programs as well as Humana's quality programs

Required Qualifications

  • Bachelor's Degree in Health Care or a related field

  • An active Registered Nurse (RN) License free of restrictions

  • 5+ years of clinical, Quality or Stars experience

  • Prior Medicare/Medicaid experience

  • Strong attention to detail and focus on process and quality

  • Excellent presentation and communication skills, both oral & written

  • Strong relationship building skills

  • Ability to operate under tight deadlines

  • Ability to work closely with collaborative remote teams

  • Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, PowerPoint and Outlook

  • This role is considered provider facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you may be required to be screened for TB

  • Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

  • Master's Degree in Business, Health Care, or a related field

  • Understanding of CMS Stars program including HEDIS, CAHPS/HOS

  • Background working in quality improvement

  • Progressive experience in the health solutions industry

  • Prior managed care experience

  • Understanding of metrics, trends and the ability to identify areas of opportunity

  • Proven organizational and prioritization skills and ability to collaborate with multiple departments

  • Coding experience

Additional Information

  • This is a work at home position and the ideal candidate must live in the Denver area.

  • Currently this position is not doing any traveling as we adhere to our company travel restriction policy due to COVID-19.

  • As the Covid-19 environment changes and we return to normal business operations, this person will be required to travel to provider offices within the Colorado area 35-40% of the time.

Scheduled Weekly Hours

40

DirectEmployers