Medicare Rn Jobs in Raleigh, NC (NOW HIRING)

Role Scope

• Transitions:Caretransition support, follow-up coordination, and avoidable readmission prevention for discharged inpatient,observationand emergency department patients.

• Quality: Medicare Advantage Stars, HEDIS and quality performance across value-basedpopulation.

• Population Health: Deliver culturallyappropriate chronicdisease education to activate patients are chronic disease self-management, particularly in DM, HTN, CHF and COPD.

Duties and Responsibilities:

• Analyze clinical data and trends from platforms such as Athena EMR andDataHubtoidentifygaps in care related to Stars and HEDIS measures and Transitions of Care and post-hospitalization needs, prioritizing high-impact opportunities.

• Proactivelyidentifyrecently discharged inpatient, observation and emergency department patients and coordinatetimelypost-discharge follow-up in alignment with TOC and Transitional Care Management (TCM) requirements, with the aim of addressing root causes ofutilizationand supporting patients to prevent avoidable readmissions or return visits.

• Conduct targeted patient and provider outreach via phone, telehealth and in-clinic visits to close care opportunities, provide tailored education on preventive care, chronic disease management, and medication management.

• Conduct post-discharge outreach to assess understanding of discharge instructions, bottles-out medication reconciliation, symptom monitoring, and follow-up appointment adherence.Identifyand escalate barriers, collaborating with providers and careteamto prevent readmissions and avoidable EDutilization.

• Collaborate effectively with interdisciplinaryteams,including providers, care assistants, center administrators, medical assistants, pharmacy, and quality improvement staff-to implement evidence-based interventions andoptimizeworkflows.

• Document all outreach efforts, clinical interactions, and outcomes accurately and in compliance with organizational and CMS regulatory standards.

• Prepare,participateand discuss patients in center huddles and high-risk rounds with providers and the center-based and interdisciplinary team.

• Participatein quality improvement projects, provider education sessions, team huddles to stay current with evolving clinical guidelines and organizational priorities.

• Monitorprogress toward Stars and Transitional Care Management goals, proactivelyidentifybarriers, and help develop innovative solutions to improve clinical performance and patient engagement.

• Support clinic operations through provider collaboration, care coordination, and community education initiatives.

• Coordination and facilitation of center and market-based Wellness Events-focused in-person engagement for Stars care opportunity closures.

• Maintainpatient confidentialityin accordance withHIPAA.

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 specificas applicable).

• 3+ years' clinical nursing experience with exposure to transitions of care, quality improvement, managed care, or population health management.

• Proficiencywith electronic health records (e.g., Athena EMR), data analytics tools (e.g.,DataHub, Compass Rose,SalesForceHealthCloud- per your prior employer's population health tools), and Microsoft Office Suite.

• Willing and able to complete andmaintainBasic Life Supporttraining.

Preferred Qualifications:

• Knowledge of Medicare Advantage Stars, HEDIS, CAHPS, and CMS quality requirements.

• Experience with Transitions of Care, hospital discharge or ERfollow upprograms.

• Strong clinical judgment, data analysis skills, and ability to apply evidence-based practices.

• Bilingual in English and Spanish with full professional proficiency.

• Excellent communication and motivational interviewing skills to educate and empower members.

• Commitment to health equity,inclusiveness, and patient-centered care.

• Basic Life Supporttrained.

Additional Information

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 managementbalancingadministrative 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:

This role requires an in-center presence, involving daily commute to assigned clinic(s) and occasional (quarterly) travel within the market to alternative clinic(s) for strategic meetings.

• Workstyle: Clinic-based, in-center 5 days per week.

• Location: Mustresidein designated market area,inreasonable commutable distance to assigned clinic(s).

• Hours: Monday-Friday, 8:00 AM-5:00 PM;additionaltime may berequired.

TB Statement:

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you willbe requiredto be screened for TB.

Driving Statement: