Humana

RN Senior Clinical Consultant

Posted on

April 4, 2025

Job Type

Full-Time

Role Type

Case Management

License

RN

State License

Florida

Apply to This Job

Help & Resources

Company Description

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Job Description

The Senior Stars Improvement, Clinical Professional (RN) is responsible for the development, implementation and management oversight of the company's Medicare Stars Program in the Florida region. *Central and North Florida areas, exclude South Florida area and Panhandle. Far north Florida limit would be Jacksonville

Requirements

Required Qualifications: Licensed Registered Nurse (RN) without restriction in Florida 5 or more years of clinical nursing experience 1 or more years of 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 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 Preferred Qualifications: Bachelor’s degree in Nursing 3 or more years years of managed care experience 3or more years years of case management experience Working knowledge of HEDIS/Stars/CMS

Need help crafting an effective cover letter and resume for this role?

Get access to our expert resources: our proven framework offers successful strategies, helps you find the best-fit positions, craft standout cover letters, optimize your resume, and much more.

Get Started

Responsibilities

Develops programs designed to increase the plan quality. Medical records reviews will be 40% of role and 60% of role is participating in strategies that will support Humana provider specific measure care gap closure. 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

Apply to This Job

Help & Resources

Our Resources Designed for Success

Nurses who follow our proven framework increase their chances of landing a remote telehealth role by 5x!

Telehealth

Starter Pack

Telehealth

Pro Toolkit

Telehealth

Mastery Suite

Price

$34 $79 $149

Resume Template Package

Checkmark Checkmark Checkmark
Matching Cover Letter Checkmark Checkmark Checkmark
Matching Reference Page Checkmark Checkmark Checkmark
Resume Tips and Tricks Checkmark Checkmark Checkmark
Resume Optimization Guide Checkmark Checkmark
7 Nurse Resume Examples Checkmark Checkmark
20+ Professional Summary Examples Checkmark Checkmark
How to Structure Unique Career Experiences Checkmark Checkmark

āœ…Career Accelerator Success Guide

Checkmark
šŸ”“Lifetime Premium Job Board Access

Checkmark
šŸ“ˆJob Application Tracker

Checkmark
⭐1:1 Expert Support & Mentorship

Checkmark

Basic

Telehealth

Starter Pack

$34

  • Checkmark

    Resume Template Package

    ATS optimized design for nurses

  • Checkmark

    Matching Cover Letter

  • Checkmark

    Matching Reference Page

  • Checkmark

    Resume Tips and Tricks

ADVANCED

Telehealth

Pro Toolkit

$79

  • Checkmark

    Everything from Starter Pack

  • Checkmark

    Resume Optimization Guide

  • Checkmark

    7 Nurse Resume Examples

  • Checkmark

    20+ Professional Summary Examples

  • Checkmark

    How to Structure Unique Career Experiences

BEST VALUE

Telehealth

Mastery Suite

$149

  • Checkmark

    Everything from Starter Pack

  • Checkmark

    Everything from Pro Toolkit

  • Checkmark

    Career Accelerator Success Guide

    Proven method for landing your dream role

  • Checkmark

    Lifetime Premium Job Board Access

  • Checkmark

    Application Tracker

  • Checkmark

    1:1 Expert Support