About Humana


Job Category:

Member Quality & Financials - Risk Adjustment & STARS operations


United States

Approximate Salary:

Not Specified

Position Type:

Full Time

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Stars Quality Nurse Mentor (RN/LPN) - Work at home, Texas only

Humana - Work At Home, Texas

Posted: 11/19/2018


The Stars Quality Nurse Mentor develops, implements, and manages oversight of the company's Medicare/Medicaid Stars Program. Directs all Stars quality improvement programs and initiatives. The Stars Quality Nurse Mentor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.


Role:                    Stars Quality Nurse Mentor Role
Assignment:      Senior Products

Location:            WAH-TX Region

Assignment Capsule
The Stars Quality Nurse Mentor Role will facilitate and work collaboratively with provider groups focused on Senior Products, Commercial and Medicaid plans to guide, document and track practice specific strategies designed to improve all aspects of Stars and Quality. The Stars Quality Nurse Mentor is also responsible for facilitating training/mentoring as assigned with internal associates in assigned local markets.

  • Critical thinking to prioritize PCP outreach based on what will deliver greatest return on investment (i.e. who to outreach, frequency of outreach, visit focus, communication method / collateral)
  • Evaluate provider current state willingness to work with Humana to improve Stars performance and tailor messaging accordingly
  • Identify key point of contact for each prioritized PCP and effectively develop / enhance provider clinical relationship across product lines.  Accurately define gaps in Humana’s service relationship with providers and facilitate resolution through Service Alignment Manager (SAM)
  • Deliver provider/member-specific metrics and supporting collateral (e.g., HEDIS Summary, Patient Experience, Rx Opportunity, etc.) and coach providers on improving all aspects of Stars performance
  • Educate PCP’s on Stars program, changes and best practices to enhance all aspects of Stars performance
  • Identify provider best practices and needs, disseminate for sharing and / or resolution
  • Maintain documentation of provider visit, including focus and performance trending (Quality Journal)
  • Facilitate effective collaboration and communication with workgroup members (including operations, clinical and MRA) and Stars and Quality team members
  • Identify opportunities to improve Stars and Quality processes, methods, team engagement, etc. and present resolution options / cost
  • Serve as a mentor to associates by assessing learning needs (content and method), providing guidance, and leadership for their day-to-day role deliverables.
    • Includes prioritization, visit effectiveness, call to action and post visit documentation
  • Participate in ongoing continuous improvement process regarding new hire onboarding packet content.
  • Assist in meeting key performance indicators by helping to remove barriers to success (at the direction of the Front Line Leader), identifying and sharing best practices and piloting changes in the TX market
  • Provide coverage for Front Line Leads in extended times of absence in all matters except personnel management.
  • Organizing and manage multiple priorities and/or projects by using appropriate methodologies and tools


Role Essentials

  • Experienced clinical background as RN or LPN
  • History of taking on roles of increased responsibilities with proven results
  • Self-directed and motivated, with proven ability to work independently given general instructions
  • Strong communication and public speaking skills; proven influencer
  • Strong organizational and prioritization skills with ability to collaborate across multiple departments
  • Detail orientated, forward looking and comfortable working with tight deadlines in a fast paced, dynamic environment
  • Demonstrated proficiency with MS Office Suite (Word, Excel and PowerPoint)

Role Desirables

  • Knowledge of CMS Stars Program elements, including HEDIS, Patient Experience and Patient Safety
  • Previous experience and/or knowledge of the Quality Improvement Nurse Role
  • Physician office practice experience
  • Previous experience and/or knowledge of Quality Improvement or process improvement
  • Strong analytic skills and ability to use data to drive improvement activities
  • Previous Health Insurance clinical or operations experience
  • Strong attention to detail and exceptional follow up skills
  • Exceptional communication skills
  • Previous experience in teaching, training, mentoring or facilitating
  • Exceptional interpersonal, public speaking and presentations skills.
  • 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.

  • Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10Mx1M

Reporting Relationships

  • This role reports to the Stars Quality Manager.

Additional Information

  • Work  at Home role traveling 75% of the time
  • This role works closely with Market Operations, MRA, HSO and Clinical teams

Scheduled Weekly Hours


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