Manager, Stars Improvement, RN

Description

Humana Healthy Horizons in Florida is seeking a Manager, Stars Improvement, Clinical responsible for the development, implementation and management oversight of the company's Medicaid Stars Program. The Manager, Stars Improvement, Clinical works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The Manager, Stars Improvement, Clinical develops programs designated to increase the plan quality. Partners with leaders regarding implementation planning. Reviews and communicates results of programs. Decision This work focuses on areas of clinical emphasis. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

• Responsible for daily operations of the clinical advisors (clinical and non-clinical) in the department, including assignment, visit tracker, develop and monitor the clinical advisor score card, issue resolution and training.
• Collaborate with cross-functional departments, including Clinical, Community Management, Member Services, and Provider Network & Contracting, to drive provider/member engagement.
• Drive enterprise adoption of a consume centric approach, leverage consume analytics in order to develop insights for member/provider engagement strategies, highly effective communication campaigns, member journeys, and programs to improve customer engagement, retention, and health outcomes.
• Define the key performance indicators to benchmark and track initiative success
• Create leadership/executive presentations that communicate opportunities and progress.

• Must reside in the State of Florida.
• Active Unrestricted Registered Nurse, (RN), License in the state of Florida.
• Bachelor's degree in health care or a related field.
• 3+ years of managed care experience.
• Experience with clinical and quality background as a RN.
• 1+ years combination professional and management experience within the following: team lead, or charge nurse, project/process leadership, or Subject Matter Expert, SME.
• Progressive business consulting and/or operational leadership experience.
• Knowledge of HEDIS quality measures.
• Proficiency in analyzing and interpreting healthcare data and trends.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint.
• Excellent written and oral communication skills.
• Strong attention to detail, focus on process, quality, and ability to operate under tight deadlines.

• Master's degree in health administration or a related field.
• Previous management/supervisor level experience to include hiring, training, coaching up to termination.
• Experience with Quality and HEDIS Medicaid.
• 3+ years of experience in the healthcare industry.
• Must be passionate about contributing to an organization focused on continuously improving consumer experience.

• At a minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Humana will provide Home of Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

• Workstyle: This is a Remote position that requires you to live in the state of Florida.
• Workdays and Hours: Monday-Friday; 40-hour work schedule.
• Travel: Possible occasional travel to team engagement meetings in the state of Florida.
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes; 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....