Clinical Care Nurse (RN)

Overview Become a part of our caring community. The Clinical Care RN (RN) is a clinic‑based nursing role focused on improving patient outcomes. The RN supports safe Transitions of Care (TOC), reduces avoidable ED utilization, and drives Medicare Advantage Stars and quality performance. The RN plays a critical role in advancing clinical quality and supporting patients across transitions of care to improve outcomes. They contribute to Medicare Advantage Stars ratings by proactively identifying care opportunities, engaging patients and providers, and driving evidence‑based interventions. The RN balances direct patient education and outreach with data‑driven quality improvement efforts, aligning daily responsibilities with organizational values of integrity, respect, empathy, and commitment to health equity. 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 a value‑based population. Population Health: Deliver culturally appropriate chronic disease education to activate self‑management for patients with DM, HTN, CHF, and COPD. Duties and Responsibilities Analyze clinical data and trends from Athena EMR and DataHub to identify gaps in care related to Stars, HEDIS, and Transitions of Care and prioritize high‑impact opportunities. Proactively identify recently discharged patients and coordinate timely post‑discharge follow‑up to address root causes of utilization and prevent avoidable readmissions. 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. Perform post‑discharge outreach to assess understanding of discharge instructions, conduct medication reconciliation, monitor symptoms, and promote follow‑up appointment adherence. Identify and elevate barriers, collaborating with providers and the care team 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 interdisciplinary team. Engage 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 Transitions of Care Management goals, identify barriers, and help 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 and document encounters accurately and timely in the indicated platform. Adhere to organizational policies related to safety, infection control, and attendance. Perform other duties as assigned. Required Qualifications 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) and data‑analytics tools (e.g., DataHub, Compass Rose, SalesForce HealthCloud). Proficiency with 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. Full‑professional bilingual proficiency in English and Spanish. 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. Core Competencies Clinical quality improvement and strategic gap closure. Transitions of 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. Work Information The role requires an in‑center presence, with daily commute to assigned clinic(s) and occasional quarterly travel to alternative clinics within the market for strategic meetings. The RN works five days per week, Monday–Friday, 8:00AM–5:00PM; additional time may be required. The RN must reside in the designated market area within reasonable commuting distance to assigned clinic(s). Benefits Humana, Inc. offers competitive benefits that support whole‑person well‑being, including medical, dental, vision, 401(k) retirement savings, time off (paid time off, holidays, volunteer time off, paid parental and caregiver leave), short‑term and long‑term disability, life insurance, and many other opportunities. Equal Opportunity Employer Humana is an equal opportunity employer. The company 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. Humana is committed to affirmative action in compliance with Section503 of the Rehabilitation Act and VEVRAA, to employ and advance individuals with disability or protected veteran status based on valid job requirements. #J-18808-Ljbffr