Stars Improvement Nurse Jobs

Strong communication, time management, and organization skills

Perform data and program management, included, but not limited to end-to-end data assessment to ensure accuracy in Stars measures

Knowledge of regulatory quality-based reporting and audit requirements

Produces and manages documents related to client projects, calls, meetings, product specifications, special initiatives and follow up.

Fully accountable for ensuring that open issues are managed in a timely manner and that no key milestones are missed.

Five (5) or more years of healthcare experience, with at least 2 years working directly in Stars, CMS, NCQA, HEDIS

Exceptional presentation, oral and written communication, interpersonal, problem solving, multitasking and time management skills required.

Knowledge and experience in Medicare and/or Quality Improvement is strongly preferred.

Qualifications and Skills, We Value

Benefits & Wellness Program including generous Time Off

Manage & track all measure rates for the Medicare Stars Program

Lead cross-functional efforts to develop, deploy, and manage reporting dashboards

Provides resources and educational opportunities to providers and staff.

Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint.

Ability to manage multiple competing priorities and meet deadlines.

Workstyle: This is a Remote position that requires you to live in the state of Florida.

Reviews provider and member-specific UM and QI metrics.

Coaches assigned providers on gaps in care opportunities through virtual, telephone and/or email.

Performs additional duties and responsibilities as assigned by management.

3-5 years of experience in Customer service experience in managed care, pharmacy or medical environment

Maintains up to date knowledge of Star measures as assigned.

Comprehensive Benefits: Medical Plans, Health Savings Account, Dental, Vision, and more…

Experience working to improve HEDIS/STARS measures preferred

Bilingual preferred; excellent member relation skills with strong interpersonal skills

Bachelor’s Degree in Management, Business, Healthcare, or a related field, or equivalent experience. (R)

Provide comprehensive analysis of measures, barriers, and opportunities, and present results of improvement efforts and ongoing performance measures to management.

Manage current quality initiatives, collaborate and educate SCFHP staff, provider network and community partners on how to improve SCFHP Star Program.

Knowledge of Medicare principles and practices with emphasis in quality improvement. (R)

Medicare Advantage plan or ACOs experience. (D)

Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)

5 years or more telephonic member outreach experience

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Health benefits effective day 1

Associate Degree in Nursing or higher

Satellite, cellular and microwave connection can be used only if approved by leadership

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information