The Senior Stars Improvement, Clinical Professional monitors assigned value-based and non-value-based provider/provider groups’ performance in key performance indicators which may include preventive care, maternal health, and identified medical metrics (ex. HEDIS, admissions, readmissions, ED utilization, polypharmacy, pre-term delivery rate, cesarean section rate, etc.). In this role, you will actively engage providers, review KPIs, improvement strategies and bi-directional feedback related to barriers and opportunities. Educate and assist providers in reducing potential preventable events through the use of data driven methods and resources related to available clinical programs. Support improvement in member experience through education, information and resources related to the annual Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and Humana’s Member Experience Medicaid Survey (MEMS).
The Senior Stars Improvement, Clinical Professional will collaborate with internal stakeholders and leaders to analyze and inform strategies for improvement in maternal health outcomes for our members and the communities we serve.
Responsibilities:
Continue to focus efforts and identify opportunities on performance improvement for assigned providers
Actively engages provider during routine virtual visits to facilitate education, HEDIS and medical metric outcomes, care of members and bi-directional feedback.
Attends joint operating committee meetings (JOCs) with providers and participates in active discussions on HEDIS, member care, and clinical/quality outcomes.
Communicate clinical quality initiatives to assigned providers
Educate and assist providers in developing strategies to reduce potential preventable events
Educate providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
Actively engage with internal stakeholders, leaders and teams to analyze and inform improvement strategies to address maternal health outcomes. Engagement may include formal and informal discussions, in individual or group settings.
Required Qualifications
FL RN License
Must reside in the state of Florida
Must have quality improvement experience in Medicaid or Medicare (Medicaid quality improvement a plus) (i.e. HEDIS, CMS Stars)
Proficient/ intermediate utilization of Excel and PowerPoint.
Prior experience in a fast-paced insurance or health care setting
Experience collaborating with cross-functional teams
Proven analytical skills
Excellent communication skills, both oral and written
Strong relationship building skills
Demonstrated ability to work independently, proactively initiate tasks, conduct thorough research, and acquire new knowledge to support ongoing development.
Conducts self in a professional manner with all verbal and written communication when working with associates, peers, and providers
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Bachelor’s degree in nursing or related field
Medical Coding Certification
Certified Professional in Healthcare Quality (CPHQ)
Knowledge of Humana's internal policies, procedures, and systems
Medicaid Health Plan Experience
Additional Information
Workstyle: Remote
Work Location: Must reside in FL
Travel: None
Typical Workdays/Hours: Monday- Friday, 8am- 5pm EST
Work-At-Home Requirements:
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format:
As part of our hiring process for this opportunity, we will be using exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for 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 inviting you to participate in a HireVue interview. In this interview, you will receive a set of interview questions you may answer via by phone or computer, and you will provide recorded or text message responses to each question. Some of the questions may require longer responses and using a computer vs phone to type responses may work best. You should anticipate this interview to take about 15-20 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Why Humana?
At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. Just to name a few:
Work-Life Balance
Generous PTO package
Health benefits effective day 1
Annual Incentive Plan
401K - with company match
Well-being program
Paid Volunteer Time Off
Student Loan Refinancing
If you share our passion for helping people, we likely have the right place for you at Humana.
Social Security Task:
Alert: Humana values personal identity protection. Please be aware that applicants being considered for an offer will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay 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.
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.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.