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