Humana Senior Stars Improvement, Clinical Quality-3 in Davenport, Iowa
The Senior Stars Improvement, Clinical Professional is responsible for the development, implementation and management oversight of results related to a regional Medicare Stars 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 including creation and execution of a related action plan.
The Senior Stars Improvement, Clinical Professionals work focuses specifically on developing relationships and influencing behaviors and processes in areas requiring clinical emphasis. The role will:
Execute and contribute to the overall Star Improvement department’s strategy
Work within specific guidelines and procedures
Apply advanced clinical knowledge to drive member patient outcomes and improved provider quality performance
Receive assignments in the form of objectives and must determine approach, resources, schedules and goals
Exercise considerable latitude in determining objectives and approaches to assignments
Require cross departmental collaboration, and conducting briefings and area meetings with internal and external partners and leaders
Maintain frequent contact with other professionals and leaders across the markets departments
An active Registered Nurse (RN) License free of restrictions
5 or more years of clinical experience
Prior Medicare experience
Strong attention to detail and focus on process and quality
Proven organizational and prioritization skills and ability to collaborate with multiple departments
Excellent communication skills
Ability to operate under tight deadlines
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits
Bachelor's Degree in Business, Finance, Health Care or a related field
Progressive experience in the health solutions industry
Prior managed care experience
Understanding of metrics, trends and the ability to identify gaps in care
Understanding of CMS Stars performance measures, HEDIS knowledge and experience
Background working in quality improvement
Coding experience a plus
This role will be based in MN, IA, NE or SD and will require regional travel.
Scheduled Weekly Hours
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 that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
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