Humana · 1 month ago
Senior Stars Clinical Consultant RN
Daytona Beach, FL
Full-time
Hybrid
Mid, Senior Level
$78K/yr - $108K/yr
5+ years expHumana is committed to putting health first for its customers and teammates. The Senior Stars Improvement Clinical Professional (RN) is responsible for overseeing the Medicare Stars Program in the Florida region, focusing on quality improvement and provider engagement.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
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 Humana 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
Develop and implement measure specific strategies
Provider and Member outreach on focused care gap measures
EMR remote strategy for Humana provider care gap closure on targeted measures
Provider office in person, Zoom virtual or telephonic meetings
Weekly metrics for provider outreach may apply, some Zoom telephonic outreach 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 related to provider performance, member experience, market growth, provider experience and operational excellence
Qualification
Required
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 Microsoft Office applications, Word and Excel 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% within the region
Preferred
Bachelor's degree in Nursing
3 or more years years of managed care experience
3 or more years years of case management experience
Working knowledge of HEDIS/Stars/CMS
Benefits
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Colin Drylie
Senior Vice President, Experience Transformation
Recent News
2026-01-09
2026-01-07
2026-01-06
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