Humana
Humana Inc. (NYSE: HUM) is committed to putting health first ā 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 ā 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.
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
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: Bachelorās 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
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
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