Humana · 10 hours ago
Senior Stars Improvement, Clinical Professional RN
United States
Full-time
Remote
Mid, Senior Level
$78K/yr - $108K/yrHumana is a healthcare company committed to putting health first. The Senior Stars Improvement, Clinical Professional is responsible for overseeing the Medicare/Medicaid Stars Program, focusing on quality improvement and performance metrics related to maternal health for Medicaid provider groups.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Continue to focus efforts and identify opportunities on performance improvement for assigned providers
Actively engages provider during routine virtual visits to facilitate education, HEDIS and medical metric outcomes, care of members and bi-directional feedback
Attends joint operating committee meetings (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 developing strategies to reduce potential preventable events
Educate providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey
Actively engage with internal stakeholders, leaders and teams to analyze and inform improvement strategies to address maternal health outcomes. Engagement may include formal and informal discussions, in individual or group settings
Qualification
Required
FL RN License
Must reside in the state of Florida
Must have quality improvement experience in Medicaid or Medicare (Medicaid quality improvement a plus) (i.e. HEDIS, CMS Stars)
Proficient/ intermediate utilization of Excel and PowerPoint
Prior experience in a fast-paced insurance or health care setting
Experience collaborating with cross-functional teams
Proven analytical skills
Excellent communication skills, both oral and written
Strong relationship building skills
Demonstrated ability to work independently, proactively initiate tasks, conduct thorough research, and acquire new knowledge to support ongoing development
Conducts self in a professional manner with all verbal and written communication when working with associates, peers, and providers
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred
Bachelor's degree in nursing or related field
Medical Coding Certification
Certified Professional in Healthcare Quality (CPHQ)
Knowledge of Humana's internal policies, procedures, and systems
Medicaid Health Plan Experience
Benefits
Work-Life Balance
Generous PTO package
Health benefits effective day 1
Annual Incentive Plan
401K - with company match
Well-being program
Paid Volunteer Time Off
Student Loan Refinancing
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.
Founded in 1964
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
2026-01-16
2026-01-14
2026-01-13
Company data provided by crunchbase