高级STARS改进临床专业人员
Senior STARS Improvement, Clinical Professional
成为我们关怀社区的一员
高级之星改进临床专业人员 这项工作专注于临床重点领域。开始影响部门的战略。对项目组件的技术方法相关中等复杂到复杂的问题做出决策，工作无需指导。在确定目标和方法方面有相当大的自主权。
继续集中精力并识别指定提供者的绩效改进机会
在虚拟访问期间积极与提供者互动，以促进教育、HEDIS 结果、成员护理和双向反馈
参加与提供者的 JOC，并参与关于 HEDIS、成员护理和临床/质量结果的积极讨论
向指定的提供者传达临床质量计划
教育并协助提供者减少潜在可预防事件
教育提供者和员工了解医疗补助消费评估医疗提供者和系统（CAHPS）调查
所需资格
- 佛罗里达州注册护士执照
- 必须居住在佛罗里达州
- 护理学士学位
- 具有医疗保险、医疗补助或双重合格人群的经验
- 在快节奏的保险或医疗保健环境中有工作经验
- 理解医疗保健质量指标 STARS、HEDIS 等
- 有与跨职能团队合作的经验
- 熟练掌握 Microsoft Office Word、Excel 和 PowerPoint
- 有扎实的分析能力
- 优秀的沟通能力，包括口头和书面
用你的技能产生影响
优先资格：
· 医疗编码认证
· 了解 Humana 内部政策、流程和系统
· 医疗补助健康计划经验
居家办公要求：为确保居家或混合办公员工能够有效工作，居家或混合办公员工自备的互联网服务必须满足以下标准：最低下载速度为25 Mbps，上传速度为10 Mbps；建议使用无线、有线电缆或 DSL 连接。在某些职位中，Humana 规定的最低推荐互联网速度可能不足以满足业务需求。Humana 保留权利在必要时要求员工升级其互联网服务。从一个专门的空间工作，避免持续干扰以保护成员的 PHI/HIPAA 信息。
差旅：虽然这是一个远程职位，但偶尔需要前往 Humana 的办公室
查看英文原文
Become a part of our caring community
The Senior Stars Improvement, Clinical Professional This work focuses on areas of clinical emphasis. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Continue to focus efforts and identify opportunities on performance improvement for assigned providers
Actively engages provider during virtual visit to facilitate education, HEDIS outcomes, care of members and bi-directional feedback.
Attends 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 reducing potential preventable events
Educate providers and staff about Medicaid Consume Assessment of Healthcare Providers and Systems (CAHPS) survey.Required Qualifications
- FL RN License
- Must reside in the state of Florida
- Bachelor's degree in nursing
- Experience with Medicare, Medicaid, or dual eligible populations
- Prior experience in a fast-paced insurance or health care setting
- Understanding of healthcare quality measures STARS, HEDIS, etc.
- Experience collaborating with cross-functional teams
- Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
- Proven analytical skills
- Excellent communication skills, both oral and written
Use your skills to make an impact
Preferred Qualifications:
- Medical Coding Certification
- Knowledge of Humana's internal policies, procedures, and systems
- Medicaid Health Plan Experience
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.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.$78,400 - $107,800 per yearThis 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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.
Originally posted on Himalayas