Job Overview
Employment Type
Full-time
Compensation
Type:
Salary
Rate:
Range $84,100.00 - $132,900.00
Work Schedule
Standard Hours
Benefits
Medical insurance
Dental Insurance
Vision Insurance
401k plan
Paid Time Off
prescription drug coverage
Life insurance
Job Description
Humana Inc. (NYSE: HUM) is a leading health and well-being company dedicated to putting health first for its teammates, customers, and communities. As part of its comprehensive service offering, Humana provides insurance services and healthcare solutions through its CenterWell services. The company serves millions of people, including those on Medicare, Medicaid, families, individuals, military service personnel, and broader communities across the United States. Humana’s mission focuses on delivering timely, effective, and high-quality care and support to help individuals achieve their best health and improve their quality of life. The organization values diversity, equal opportunity, and inclusiveness, ensuring a supportive environment... Show More
Job Requirements
- Licensed Registered Nurse (RN) without restriction in Florida
- Five or more years of clinical nursing experience
- One or more years of experience with electronic medical records systems and medical records auditing in the past five years
- One or more years of experience in provider office or clinic management in the past five years
- One or more years of experience visiting providers or members
- Comprehensive knowledge of Microsoft Office applications including Word, Excel, and advanced PowerPoint skills
- Excellent oral and written communication skills
- Strong relationship building skills for provider-facing role
- Strong attention to detail with a focus on process and quality
- Valid driver’s license with reliable transportation and ability to travel up to 40% within the region
Job Qualifications
- Licensed Registered Nurse (RN) without restriction in Florida
- Five or more years of clinical nursing experience
- One or more years of experience with electronic medical records systems and medical records auditing in the past five years
- One or more years of experience in provider office or clinic management in the past five years
- One or more years of experience visiting providers or members
- Comprehensive knowledge of Microsoft Office applications including Word, Excel, and advanced PowerPoint skills
- Excellent oral and written communication skills
- Strong relationship building skills for provider-facing role
- Strong attention to detail with a focus on process and quality
- Valid driver’s license with reliable transportation and ability to travel up to 40% within the region
- Bachelor’s degree in Nursing preferred
- Three or more years of managed care experience preferred
- Three or more years of case management experience preferred
- Working knowledge of HEDIS, Stars, and CMS preferred
Job Duties
- Develop programs designed to increase plan quality
- Conduct medical records reviews and provide EMR remote provider gap closure support
- Participate in Stars new pilot strategies for Medicare measure care gap closure
- Perform provider office in-person visits up to 40% of the time
- Partner with leaders on implementation planning and review program results
- Analyze provider non-standard supplemental data trends
- Provide provider-level HEDIS in-service training
- Develop and implement measure specific strategies
- Conduct provider and member outreach on focused care gap measures
- Utilize EMR remote strategies for care gap closure
- Facilitate provider meetings in office, virtual, or telephonic formats
- Manage weekly metrics for provider outreach including cold calling
- Support quality, clinical management, and population health initiatives
- Monitor HEDIS and Stars performance
- Drive operational improvements and financial performance
- Support data sharing, interoperability, documentation, and coding
- Contribute to improved provider performance, member experience, market growth, and operational excellence
Job Qualifications
Experience
Expert Level (7+ years)
Job Location
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