Quality RN - North Charleston SC

Become a part of our caring community and help us put health first

The Quality RN Professional responsible for the development, implementation and management oversight of the company's Medicare / Medicaid Stars Program. The Quality RN Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Quality RN Professional collaborates with market leadership, and quality improvement team to develop and implement programs designed to increase patient outcomes. Work is performed within the associate’s assigned center locations and in collaboration with existing Quality Improvement Coordinators and Professionals and in close partnership with market and center teams.

The Quality RN Professional represents the scope of provider relationships across the following areas :

Quality / clinical management and population health

HEDIS and Stars performance

Operational improvements

Financial performance and incentive programs

Data sharing and connectivity

Documentation and coding

Additional areas related to provider performance, member experience, market growth, provider experience and operational excellence

Required Qualifications

Use your skills to make an impact

Licensed Registered Nurse (RN) without restriction in applicable state

5+ years of clinical nursing experience

Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement

Strong knowledge of HEDIS / Stars / CMS

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

Comprehensive knowledge of Microsoft Office applications

Preferred Qualification

Bachelor’s Degree in Nursing

3+ years of managed care experience

3+ years of case management experience

Bilingual; English and Spanish preferred, not required

Additional Information

Hours for the role : Monday-Friday 8am-5pm local time zone

This role is based within the provider office with regular rotation through each center within the assigned territory.

This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

This role is part of CenterWell’s driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person / $25,000 bodily injury per event / $10,000 for property damage or whichever is higher.

Scheduled Weekly Hours

40

Pay 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.

$71,100 - $97,800 per year

This 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About CenterWell Senior Primary Care : CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.

About CenterWell, a Humana company : CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE : HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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.