RN -Senior Stars Improvement Clinical Professional - Must reside in New Mexico

Profile

Description

The Senior Stars Improvement, Clinical Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve quality performance. 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

Responsibilities

The Senior Stars Improvement Clinical Professional's work focuses on quality improvement programs across such areas as quality performance, incentive programs, population health, data sharing, connectivity, documentation, HEDIS and Stars performance, operational improvements and other areas as they relate to provider quality performance and member experience. Influences provider group strategy. Makes decisions on moderately-complex to complex issues and work is performed without direction.


Effectively develop, enhance and maintain provider relationships (in-person & virtual meetings)

Review and communicate to provider partners results of Humana Quality programs
Deliver provider/member-specific metrics and effectively coach/support provider office staff on best practices to improve quality performance
Collaborate with internal and external stakeholders to improve regional quality performance
Identify Specific Practice needs to provide support 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
Strong attention to detail and focus on process and quality
Enthusiasm and motivation essential; a confident change-agent; strong presentation skills (oral and written)
Strong relationship building skills
Ability to operate under tight deadlines
Proven organizational and prioritization skills and ability to collaborate with multiple remote departments
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, PowerPoint and Outlook
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
Must reside in New Mexico

Preferred Qualifications
Master's Degree in Business, Health Care, or a related field
Understanding of CMS Stars program including HEDIS, CAHPS/HOS
Experience in provider relations and education
Background working in quality improvement
Progressive experience in payer/managed care
Understanding of metrics, trends and the ability to identify areas of opportunity
Coding experience
Additional Information
To be considered for this role you must live in New Mexico and be willing to travel locally to provider offices throughout the state, up to 40% of the time with some overnight stays
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 continue to work from home and be required to do local travel to provider offices within the New Mexico area up to 40% of the time with some overnight stays. Scheduled Weekly Hours 40


Scheduled Weekly Hours

40

Company info

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