Quality RN - North Charleston SC

Quality RN - North Charleston SC Humana

Become a part of our caring community and help us put health first

The Quality RN Professional is responsible for the development, implementation, and management oversight of Humana’s Medicare/Medicaid Stars Program. The role involves varied assignments that often require independent interpretation of the appropriate courses of action.

The Quality RN Professional collaborates with market leadership and the quality improvement team to develop and implement programs designed to increase patient outcomes. Work is performed within the assigned center locations and in collaboration with Quality Improvement Coordinators, other Professionals, and market and center teams.

The Quality RN Professional represents the scope of provider relationships across the following areas:

• Quality/clinical management and population health
• HEDIS and Stars performance
• Operational improvements
• Financial performance and incentive programs
• Data sharing and connectivity
• Documentation and coding
• Additional areas related to provider performance, member experience, market growth, provider experience, and operational excellence

Use your skills to make an impact

• Licensed Registered Nurse (RN) without restriction in the applicable state
• 5+ years of clinical nursing experience
• Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement
• Strong knowledge of HEDIS/Stars/CMS
• Excellent presentation and communication skills, both oral and written
• Strong relationship building skills as this is a provider-facing role
• Strong attention to detail with a focus on process and quality
• Comprehensive knowledge of Microsoft Office applications

• Bachelor’s degree in Nursing
• 3+ years of managed care experience
• 3+ years of case management experience
• Bilingual;
  English and Spanish preferred, not required

• Hours:
  
  Monday‑Friday 8:00 AM–5:00 PM local time zone
• This role is based within the provider office with regular rotation through each center within the assigned territory.
• This role is part of Humana’s Tuberculosis (TB) screening program. If selected, you will be required to be screened for TB.
• This role is part of Center Well’s driver safety program and therefore requires a valid state driver’s license. The individual is expected to maintain personal vehicle liability insurance as required by the residing state or the higher of $25,000 bodily injury per person / $25,000 bodily injury per event / $10,000 property damage.

Scheduled Weekly Hours 40

Pay Range

The compensation range reflects a good faith estimate of the starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 per year. This position is eligible for a bonus incentive plan based on company and/or individual performance.

Humana, Inc. and its affiliates offer competitive benefits that support whole-person well-being. Associate benefits encourage personal wellness and smart healthcare decisions for you and your family while recognizing that life extends beyond work. Benefits include medical, dental, and vision coverage; a 401(k) retirement savings plan; paid time off, company and personal holidays, and volunteer time off; paid parental and caregiver leave;

short-term and long-term disability; life insurance; and many other opportunities.

Center Well Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment, and more. The unique care model focuses on personalized experiences, listening, learning, and addressing factors that impact patient well‑being. Integrated care teams spend up to 50% more time with patients, offering compassionate, personalized care that yields better health outcomes.

The approach also addresses emotional and social wellness.

Center Well creates experiences that put patients at the…