RNClinical Case ManagementManaged CareHEDIS/Stars/CMS
Posted Jul 28, 2026 · Last seen active Aug 5, 2026
What the posting states
Base pay
$78k–$108k/yr
About this role
Show full description
The Senior Stars Clinical Consultant (RN) is responsible for the implementation and management oversight of the company's Medicare Stars Program in the Florida region. Develops programs designed to increase plan quality. Partners with leaders regarding implementation of Stars gap closure campaigns. Key responsibilities include leading measure-specific Medicare Stars gap closure campaigns, conducting medical record reviews, supporting EMR-based provider gap closure, performing member telephonic outreach, engaging providers through in-person visits and virtual meetings, partnering with measure leaders and internal teams, providing clinical expertise and provider education, and identifying opportunities to improve documentation, coding, and operational excellence.
Requirements
Licensed Registered Nurse (RN) without restriction in Florida
Valid driver's license with reliable transportation and ability to travel up to 30% within the State of Florida
5+ years of clinical nursing experience
1+ years electronic medical records systems and Medical Records auditing experience in the past 5 years
1+ years provider office and/or clinic management experience in the past 5 years
Experience visiting providers
Presentation experience using PowerPoint
Knowledge of Microsoft Office applications, Word and Excel
Benefits
Medical insurance
Dental insurance
Vision insurance
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental leave
Paid caregiver leave
About the employer
Humana
Hiring organization
Humana is a health insurance and managed care organization that employs nurses in care management roles rather than traditional clinical settings. These nurses partner with members and their families to identify needs, address barriers to care, and connect them with…
What reviewers appreciate
+Holistic, member-centered approach to care coordination
+Autonomous field-based role with telephonic and face-to-face interactions
+Collaborative work with providers and community resources
What reviewers flag
−Field-based role likely requires significant travel across assigned regions
−Complex care coordination across multiple settings and providers may be administratively demanding
−Managing Medicaid populations may involve high-acuity members with complex social and clinical needs
