Job Description

Job Description

Become a part of our caring community and help us put health first
The Quality RN Professional responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Quality RN Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Quality RN Professional collaborates with market leadership, and quality improvement team to develop and implement programs designed to increase patient outcomes. Work is performed within the associate’s assigned center locations and in collaboration with existing Quality Improvement Coordinators and Professionals and in close partnership with market and center teams.

 

The Quality RN Professional represents the scope of provider relationships across the following areas: 

• Quality/clinical management and population health 

• HEDIS and Stars performance 

• Operational improvements

• Financial performance and incentive programs 

• Data sharing and connectivity 

• Documentation and coding

• Additional areas related to provider performance, member experience, market growth, provider experience and operational excellence 

 

Use your skills to make an impact

 

Required Qualifications   

• Licensed Registered Nurse (RN) without restriction in applicable state 

• 5+ years of clinical nursing experience 

• Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement 

• Strong knowledge of HEDIS/Stars/CMS 

• 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 

• Comprehensive knowledge of Microsoft Office applications 

 

Preferred Qualification  

• Bachelor’s Degree in Nursing 

• 3+ years of managed care experience 

• 3+ years of case management experience 

• Bilingual; English and Spanish preferred, not required 

 

 

Additional Information  

• Hours for the role: Monday-Friday 8am-5pm local time zone  

• This role is based within the provider office with regular rotation through each center within the assigned territory.  

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$71,100 - $97,800 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.

About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Job Tags

Full time, Temporary work, Apprenticeship, Work experience placement, Work at office, Local area, Flexible hours, Monday to Friday,

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