STARS Clinical Consultant

Role: STARSClinical Consultant

Assignment: Sr.Segment - Quality Improvement

Location: Chicago,IL/Waukesha, WI/Minneapolis, MN

Assignment

Outward facing role traveling throughout the region. The STARS Clinical Consultant will facilitate and work collaboratively with provider groups focused on Senior Products, recommend and develop practice specific strategies designed to improve all aspects of quality.


  • Develop, enhance and maintain provider clinical relationship across product lines
  • Collaborate with other internal teams to provide reporting and education to health systems
  • Offer Best Practices solutions for stars related quality concerns around HEDIS and Patient Experience
  • Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support
  • Review medical records and identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture, use SQR to identify information and provide guidance to practice)
  • Effectively coach provider office staff on best means to communicate with Senior members that may have hearing, vision, physical abilities challenges (i.e. Perfect Service orientation)
  • Educate provider groups on HEDIS, CAHPS, HOS and Stars
  • Develop Implement initiatives at the provider, state or market level to drive stars improvement
  • Offer creative solutions to complex quality issues such as non-compliance, access to care and cost barriers within the region



Role Essentials

  • Active RN license
  • Ability to be licensed in multiple states without restrictions
  • Strong knowledge of HEDIS and STARS quality measures
  • Proven successful experience in completing efficient health-related research, with associated analysis and conclusions
  • Excellent PC skills (including MS Word, PowerPoint and Excel) required.
  • Excellent communication skills, written and verbal
  • Proven ability giving presentations to internal and external customers
  • Strong organizational skills
  • Ability to travel daily and overnight within the region up to 25% of the time

Role Desirables

  • Education: Associate or Bachelor's degree in Nursing
  • Health Plan experience
  • Knowledge of Humana Quality Systems

Reporting Relationships

  • You will report to a Clinical Manager. This area is under the leadership of the SVP & Chief Operations Officer.

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.

After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what’s happening around our organization in the changing world of healthcare.


Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.