Clinical Care Nurse (RN) - Tampa

Overview The Clinical Care Nurse (RN) is a clinic-based nursing role focused on improving patient outcomes. You will support safe transitions of care (TOC), reduce avoidable ED utilization, and drive Medicare Advantage Stars and quality performance. The Clinical Care RN plays a critical role in advancing clinical quality and supporting patients across transitions of care. Conviva clinic locations may be available in the following areas: Tampa, FL – Hanley and Hudson. As a Clinical Care RN, you will contribute to Medicare Advantage Stars ratings by proactively identifying care opportunities, engaging patients and providers, and driving evidence-based interventions. You will balance direct patient education and outreach with data-driven quality improvement efforts. The role aligns daily responsibilities with organizational values of integrity, respect, empathy, and commitment to health equity to enhance patient health outcomes and satisfaction. Role Scope Transitions: Care transition support, follow-up coordination, and avoidable readmission prevention for discharged inpatient, observation, and emergency department patients. Quality: Medicare Advantage Stars, HEDIS, and quality performance across value-based populations. Population Health: Deliver culturally appropriate chronic disease education to activate patients in self-management, particularly in diabetes, hypertension, CHF, and COPD. Duties and Responsibilities Analyze clinical data and trends from platforms such as Athena EMR and DataHub to identify gaps in care related to Stars and HEDIS measures and transitions of care, prioritizing high-impact opportunities. Proactively identify recently discharged inpatient, observation, and emergency department patients and coordinate timely post-discharge follow-up in alignment with TOC and Transitional Care Management (TCM) requirements. Conduct targeted patient and provider outreach via phone, telehealth, and in-clinic visits to close care opportunities and provide tailored education on preventive care, chronic disease management, and medication management. Conduct post-discharge outreach to assess understanding of discharge instructions, perform medication reconciliation, monitor symptoms, and ensure follow-up appointment adherence. Identify and address barriers, collaborating with providers and care teams to prevent readmissions and avoidable ED utilization. Collaborate effectively with interdisciplinary teams, including providers, care assistants, center administrators, medical assistants, pharmacy, and quality improvement staff to implement evidence-based interventions and optimize workflows. Document all outreach efforts, clinical interactions, and outcomes accurately and in compliance with organizational and CMS regulatory standards. Participate in patient huddles and high-risk rounds with providers and the center-based and interdisciplinary team. Participate in quality improvement projects, provider education sessions, and team huddles to stay current with evolving clinical guidelines and organizational priorities. Monitor progress toward Stars and Transitional Care Management goals, identify barriers, and develop innovative solutions to improve clinical performance and patient engagement. Support clinic operations through provider collaboration, care coordination, and community education initiatives. Coordinate and facilitate center and market-based wellness events focused on Stars care opportunity closures. Maintain patient confidentiality in accordance with HIPAA. Document patient encounters accurately and timely in the indicated platform (e.g., medical record). Follow organizational policies related to safety, infection control, and attendance. Perform other duties as assigned. Required Qualifications Must meet one of the following requirements: Associate's degree in nursing (ADN) or Bachelor's degree in nursing (BSN). Active, unrestricted RN license (state specific as applicable). 3+ years of clinical nursing experience with exposure to transitions of care, quality improvement, managed care, or population health management. Proficiency with electronic health records (e.g., Athena EMR), data analytics tools (e.g., DataHub, Compass Rose, Salesforce HealthCloud), and Microsoft Office Suite. Willing and able to complete and maintain Basic Life Support training. Preferred Qualifications 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. Commitment to health equity, inclusiveness, and patient-centered care. Bilingual in English and Spanish with full professional proficiency. Basic Life Support trained. Core Competencies Clinical quality improvement and strategic gap closure. Transitional care coordination and post-discharge support. Member and provider engagement with motivational interviewing. Regulatory compliance and documentation accuracy. Data interpretation and actionable reporting. Cross-functional collaboration and teamwork. Time management balancing administrative and outreach duties. Values & Mission Alignment Demonstrate integrity, respect, and empathy in all interactions. Uphold the mission to improve health outcomes and member satisfaction through proactive, compassionate care. Champion continuous learning, innovation, and professional growth. Work Information Workstyle: Clinic-based, in-center 5 days per week. Location: Must reside in designated market area, in reasonable commutable distance to assigned clinic(s). Hours: Monday–Friday, 8:00 AM–5:00 PM; additional time may be required. TB Statement This role is a patient-facing position and is part of Humana's Tuberculosis (TB) screening program. Selected candidates will be required to be screened for TB. Driving Statement This role requires a valid state driver's license and personal vehicle liability insurance as part of Humana's driver safety program. Vehicles must carry insurance meeting state minimum limits or a specified minimum coverage. Scheduled Weekly Hours 40 hours Pay Range $71,100 – $97,800 per year. This range may vary based on geographic location and individual qualifications. The role may be eligible for a bonus incentive plan. Description of Benefits Humana, Inc. and its affiliates offer competitive benefits that support whole-person well-being. Benefits include medical, dental, vision, 401(k) retirement savings plan, paid time off (including holidays and volunteer time), paid parental and caregiver leave, short-term and long-term disability, life insurance, and additional opportunities. Equal Opportunity Employer Humana is an equal opportunity employer. It does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. The policy applies to all employment actions, including recruitment, hiring, promotion, transfer, and compensation. #J-18808-Ljbffr Conviva Senior Primary Care