RN Senior Clinical Consultant

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.

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

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