HEDIS Clinical Manager, RN - Full-time / Part-time

Role: HEDIS Clinical Manager, RN Assignment: Quality Improvement Location: Office based or work at home in Florida Humana's dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana's Perfect Service means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares. Assignment Capsule CarePlus is seeking a Clinical Manager to focus on quality improvement pertaining to HEDIS Stars measures. You will lead and guide remote team members in identifying gaps in core measures and provide integrated solutions to and for our providers and customers. Provide ongoing associate coaching and feedback to enhance associate contribution, competency, and performance . Support the CMO in identifying and implementing strategies to enhance achieving targeted goals. This role will be based out of one of our main offices in FL and will require travel as needed throughout the Florida Market. You will be responsible for: Oversee team daily operations Achieve performance metrics for a fast paced clinical environment Develop team members and create strategic department process flows and improvements Contribute to execution of market outreach activities Develop and execute strategy customized to the needs of our providers Make recommendations to CMO through detailed analysis/consideration of development issues, hi-potential risks, talent succession plans, and compliance with all associate development Develop and review metrics and translate into actionable items based on group specific Weekly review of QINs metrics/productivity Oversee associates' needs based on performance Monitor staff compliance with confidentiality of member, provider, and medical information Identifies opportunities and recommends methods to improve service, work processes and performance Assists QINs as necessary in the completion of tasks and assignments to ensure continuity of service Key Competencies Interpersonal Effectiveness: Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships. Leads Positively: Leads by example to cultivate a climate of motivation, positive energy and meaning in work. Assesses, selects, recognizes, develops, and empowers diverse talent. Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same. Role Essentials Active RN license in the state of Florida without restrictions Bachelor's Degree CMS Stars/performance measures/HEDIS knowledge and experienceExperience identifying quality indicators and integrating process improvements Progressive experience in quality improvement (HEDIS stars measures) with emphasis with leading and managing teams, minimum 2 years' experience Proficiency in analyzing and interpreting financial trends Comprehensive knowledge of Microsoft Office applications Strong interpersonal & relationship building skills Strong analytical skills, able to manipulate and interpret data Clinical practice experience Excellent Organizational and prioritization skills Previous management/supervisory experience Experience in educating new employees/continued education to employees Role Desirables BSN or advanced degree Medicare experience Care Management Reporting Relationships You will have several direct reports, and you will report to the Chief Medical Officer and/or Medical Director. Additional Information At Humana, we know your well-being is important to you, and it's important to us too. That's why we're committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.