Bilingual Quality RN - N Bay Village

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

The Stars Improvement, Clinical Professional (RN) is responsible for the development, implementation and management oversight of the Primary Care Organization’s Stars Program in the South Florida market. The Stars Improvement, Clinical Professional (RN) works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Quality RN Professional collaborates with market leadership, and quality improvement team to develop and implement programs designed to improve patient outcomes. Work is performed within the associate’s primary center location and in collaboration with existing Quality Improvement Coordinators and Professionals and in close partnership with market and center teams. Patient interaction is required for this role and is completed both telephonically and through in-person visits for activities such as patient education, point-of-care testing and screenings as needed (including Retinavue eye exams, HgA1c draws, etc).

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

• Data sharing and connectivity

• Documentation and coding

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

Use your skills to make an impact

Required Qualifications

• Licensed Registered Nurse (RN) without restriction in applicable state

• 5+ years of clinical nursing experience, which can be a combination of LPN and RN experience

• Bilingual; English and Spanish required

Preferred Qualification

• Strong knowledge of HEDIS/Stars/CMS

• Bachelor’s Degree in Nursing

• 3+ years of managed care experience

• 3+ years of case management experience

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

• 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

Additional Information

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

• This role is based within the provider office with occasional rotation through other centers within the assigned territory.

TB Statement

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.

Driving Statement

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 Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' 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.

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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.

Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options