Humana, Inc.

Clinical Care Nurse - Florida

North Miami Beach, FL · Full-time

Sponsorship not specified$71k-$98kDetected 14 hours ago

Data AnalysisComplianceSalesforceEHR/EMRPatient CareCommunicationCollaborationTime ManagementMicrosoft Office

About the role

The Clinical Care RN plays a critical role in advancing clinical quality and supporting patients across transitions of care to improve patient outcomes.
You will balance direct patient education and outreach with data-driven quality improvement efforts.
The Clinical Care RN aligns daily responsibilities with organizational values, integrity, respect, empathy, and commitment to health equity - to enhance patient health outcomes and satisfaction.

Responsibilities

Document all outreach efforts, clinical interactions, and outcomes accurately and in compliance with organizational and CMS regulatory standards.
Monitor progress toward Stars and Transitional Care Management goals, proactively identify barriers, and help develop innovative solutions to improve clinical performance and patient engagement.
Maintain patient confidentiality in accordance with HIPAA.
This role is part of Humana'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.

Requirements

Associate's degree in nursing (ADN) -OR- Bachelor's degree in nursing (BSN).
additional time may be required.
If selected for this role, you will be required to be screened for TB.

Nice to have

Knowledge of Medicare Advantage Stars, HEDIS, CAHPS, and CMS quality requirements.
Experience with Transitions of Care, hospital discharge or ER follow up programs.
Strong clinical judgment, data analysis skills, and ability to apply evidence-based practices.
Excellent communication and motivational interviewing skills to educate and empower members.
Bilingual in English and Spanish with full professional proficiency (strongly preferred).
Additional Information: Core Competencies: Clinical quality improvement and strategic gap closure.
Member and provider engagement with motivational interviewing.
Regulatory compliance and documentation accuracy.

Compensation

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.

Benefits

Deliver culturally appropriate chronic disease education to activate patients are chronic disease self-management, particularly in DM, HTN, CHF and COPD.
Uphold the mission to improve health outcomes and member satisfaction through proactive, compassionate care.
Champion continuous learning, innovation, and professional growth.
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.
Conduct targeted patient and provider outreach via phone, telehealth and in-clinic visits to close care opportunities, provide tailored education on preventive care, chronic disease management, and medication management.
Participate in quality improvement projects, provider education sessions, team huddles to stay current with evolving clinical guidelines and organizational priorities.
Support clinic operations through provider collaboration, care coordination, and community education initiatives.
Coordination and facilitation of center and market-based Wellness Events-focused in-person engagement for Stars care opportunity closures.
Document patient encounters accurately and timely in the indicated platform (e.g., medical record).

Company info

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 Humana's Primary Care Organization, which includes 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 is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do.
The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized.
CenterWell is part of Humana Inc. (NYSE: HUM).
Learn more about what we offer at CenterWell.com.
CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do.
As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients.
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.
Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more.

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.

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