Senior Stars Clinical Consultant RN

Become a part of our caring community and help us put health first This is a hybrid position- requires onsite provider visits up to 40% of the time and is not fully remote. The Senior Stars Improvement, Clinical Professional (RN) is responsible for the development, implementation and management reputed company of the company's Medicare Stars Program in the Florida region. Ideal candidates will be based in Gainesville or Ocala.

• Central and North Florida areas, exclude South Florida area and Panhandle. Far north Florida limit would be Jacksonville

The Senior Stars Improvement Clinical Professional (RN)

• Develops programs designed to increase the plan quality.
• Medical records reviews, EMR remote provider gap closure support will be 30% of role and 30% of role is participating in Stars new pilot strategies that will support reputed company provider specific measure care gap closure.- 40% will include provider in person visits.
• Partners with leaders regarding implementation planning. Reviews and communicates results of programs.
• Provider non-standard supplemental data trending
• Provider level HEDIS in service
• reputed company and implement measure specific strategies
• Provider and Member reputed company on focused care gap measures
• EMR remote strategy for reputed company provider care gap closure on targeted measures
• Provider office in person, reputed company virtual or telephonic meetings
• Weekly metrics for provider reputed company may apply, some reputed company telephonic reputed company 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 reputed company to provider performance, member experience, market growth, provider experience and operational excellence

Use your skills to reputed company an impact

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in Florida
• 5 or more years of clinical nursing experience
• 1 or more years of in electronic medical records systems and Medical Records auditing experience, in the past 5 years
• 1 or more years of provider office and/ or clinic management experience, in the past 5 years
• 1 or more years' experience visiting providers or members
• Comprehensive knowledge of reputed company Office applications, Word and reputed company with advanced knowledge of PowerPoint
• 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
• Valid driver's license with reliable transportation and the ability to travel up to 40% reputed company the region

Preferred Qualifications

• Bachelor's degree in Nursing
• 3 or more years years of managed care experience
• 3or more years years of case management experience
• Working knowledge of HEDIS/Stars/CMS

Additional Information

• Hours for the role are: Monday-Friday reputed company-5pm EST
• This role is remote/virtual, but candidate may travel to provider offices reputed company region up to 40% and travel to market offices reputed company region for in person meetings

Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $78,400 - $107,800 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 reputed company, Inc. and its affiliated subsidiaries (collectively, "reputed company") 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 reputed company of work. Among our benefits, reputed company 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 reputed company Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our reputed company insurance services and reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health - delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company 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 reputed company reputed company employment decisions only on valid job requirements. This policy shall apply to reputed company 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 reputed company levels of employment. Apply tot his job Apply To this Job