12 days old

RN Sr. Stars Improvement - Jacksonville, Pensacola, Tallahassee Florida Market Locations

Jacksonville, FL 32232
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Description The Senior Stars Improvement, Clinical Professional responsible for the development, implementation and management oversight of the company's Medicaid 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. Responsibilities General Duties/Responsibilities: + Review provider/member-specific UM and QI metrics and coach assigned providers/providers groups and/or MSO groups on gap closing opportunities and improve quality outcome through in-person/virtual/telephone/email and/or JOC meeting. + Provide resources and educational opportunities to providers and staff. + Promote practice-patients participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement. + Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support. + Review medical records or claims to identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture and provide guidance to practice). + Prepare quality slide and present quality/UM/CM slides at JOC meeting. + Educate providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Required Qualifications + RN with license in the state of FL without any restrictions + 3+ years of clinical experience + Strong knowledge of HEDIS, STARS, Medicaid, Quality + Understanding of metrics, trends and the ability to identify gaps in care + Strong organizational and prioritization skills with ability to collaborate with multiple departments + Detail orientated and comfortable working with tight deadlines in a fast-paced environment + Ability to work independently under general instructions, self-directed and motivated + Excellent written and oral communication skills + Excellent PC skills (including MS Word, Excel and PowerPoint) Additional Qualifications + Hours: 40-hour work schedule Monday-Friday, hours will be discussed with the leader. + Location: The workstyle for this position is remote/work at home + Work at home: The business prefers candidates to reside within reasonable distance to Humana market office locations. + Jacksonville + Pensacola/Tallahassee + Travel: Average 50% or more based on business needs. + Work At Home Requirements: + Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work + Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited) Preferred Qualifications + Bachelor's Degree in Business Administration, Health Administration or a related field + Progressive experience in the health solutions industry + Prior managed care experience + Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus + Coding experience a plus + Additional Information Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isnt missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>


Jobs Rated Reports for Registered Nurse

Posted: 2020-02-07 Expires: 2020-03-08

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RN Sr. Stars Improvement - Jacksonville, Pensacola, Tallahassee Florida Market Locations

Jacksonville, FL 32232

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Registered Nurse
118th2018 - Registered Nurse
Overall Rating: 118/220
Median Salary: $70,000

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