RN Senior STARS Improvement Professional - Broward and ...

DescriptionThe Senior STARS Improvement Professional develops, implements, and manages oversight of the company''s Medicare/Medicaid Stars Program. Directs all Stars quality improvement programs and initiatives. The Senior STARS Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.ResponsibilitiesThe Senior Stars Improvement Professional will facilitate and work collaboratively with provider groups focused on Medicare plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality and patient experience.Effectively develop, enhance and maintain provider clinical relationshipPrepare, analyze and present provider/member-specific metrics surrounding clinical and patient experience measures through market reporting. Coach providers on gap closing opportunities for Humana membersAccurately define gaps in Humana''s service relationship with providers and facilitate resolutionIdentify specific practice needs (e.g. use of most efficient interaction channel) to providing supportReview medical records and identify needed improvements that impact HEDIS or Star measures or codingEffectively coach provider office staff on best means to communicate with Senior members that may have hearing, vision, and physical challengesWork collaboratively with Humana''s internal departments locally and nationally in support of providers and groupsUnderstands department, segment and business operating objectives, including their linkages to StarsMakes decisions regarding own work methods, occasionally in ambiguous situations; is able to conduct dailyAdditional Job DescriptionRequired QualificationsAn active Registered Nurse (RN) License in Florida5 or more years of clinical experienceStrong attention to detail and focus on process and qualityStrong verbal and written communication skillsAbility to operate under tight deadlinesProven organizational and prioritization skills and ability to collaborate with multiple departmentsComprehensive knowledge of all Microsoft Office applications, including Access, Excel and OutlookMust be passionate about contributing to an organization focused on continuously improving consumer experiencesFor this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are ahealthcarecompany committed to putting health and safety first for our members, patients, associates, and the communities we serve.If progressed to offer, you will be required to:* Provide proof of full vaccinationor commit to testing protocols *OR* * Provide proof of applicable exemption including any required supporting documentationPreferred QualificationsBachelor''s Degree in Business, Finance, Health Care or a related fieldProgressive experience in the health solutions industryPrior managed care experiencePrior Medicare/Medicaid experienceUnderstanding of metrics, trends and the ability to identify gaps in careUnderstanding of CMS Stars, performance measures, HEDIS knowledge and experience a plusBackground working in quality improvementsCoding experience a plusAdditional InformationThis is currently a Work at Home/virtual position however when travel is allowed this position will be in field visiting provider offices in the Broward/Palm Beach areaLI-JR2Scheduled Weekly Hours40

Created: 2025-10-04