Nurse Clinical Lead - Provider Education
Location
United States
Posted
1 day ago
Salary
$104K - $143K / year
Seniority
Lead
No structured requirement data.
Job Description
Nurse Clinical Lead - Provider Education
Humana
Role Description The Nurse Clinical Lead reports to, and partners closely with, the National Medical Director, Risk Adjustment and Stars. They support corporate and regional strategies for provider success in Medicare Stars, Risk-Adjustment (MRA), and Interoperability. This individual provides clinical and coding expertise and serves a vital individual contributor role. They provide clinical guidance for programs, policies, and educational materials to optimize provider performance in these domains. - Inform clinical strategy and increase adoption of Humana's Stars, MRA, and Interoperability programs - Serve as a clinical coding expert, which may include working through escalations on coding disputes, policy development or refinement, and coordination and education with providers or Humana associates - Serve as a clinical consultant and subject-matter expert in MRA and Stars across the Quality and Cost Strategy organization - Serve as the first-line clinical resource as appropriate for the MRA, Stars, and Interoperability teams - Co-develop internal and external provider education materials for MRA, Stars, Utilization Management and Trend - Educate and train market associates - Provide Clinical Support to Provider Education, Communication, and Strategy teams - also reporting to the National Medical Director, Risk Adjustment and Stars Qualifications - Registered Nurse (RN) - At least 5 years of clinical experience in a healthcare setting - Medical Coding Certification (CPC or equivalent) - Strong knowledge of Medicare Risk Adjustment - Strong knowledge of Medicare Stars - Significant experience educating and influencing the behavior of healthcare providers - Proven track-record of driving provider practice improvement, including in MRA and Stars - Exceptional communication and interpersonal skills with the ability to quickly build rapport at all levels within an organization Requirements - To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. - In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. - While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Benefits - Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being. - Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family. - Among our benefits, Humana provides: - Medical, dental and vision benefits - 401(k) retirement savings plan - Time off (including paid time off, company and personal holidays, paid parental and caregiver leave) - Short-term and long-term disability - Life insurance - Many other opportunities
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UniTriTeamAt UniTriTeam, we believe people make the difference. We support teams in the clinical research space by providing global, remote talent that integrates seamlessly into your workflow. You’ll be part of a company that is mission-driven, people-first, and proud to support breakthroughs in medicine.
Role Description The Quality Specialist is responsible for conducting quality control reviews of participant visits and source documentation within the CRIO eSource system. This role ensures that clinical documentation is complete, accurate, protocol-compliant, and aligned with Good Clinical Practice (GCP), ALCOA principles, and our clients' quality standards. This position requires an extremely detail-oriented individual who can identify inconsistencies, documentation gaps, and potential compliance concerns before they impact study quality. The ideal candidate has previous experience as a Clinical Research Coordinator (CRC), Regulatory Specialist, or clinical research quality professional and can quickly adapt to established quality review processes. - Review completed participant visits within the CRIO eSource platform using established quality control processes. - Verify that all protocol-required procedures, assessments, and documentation have been completed accurately and appropriately documented. - Review source documentation to ensure compliance with study protocols, sponsor expectations, site SOPs, and applicable regulations. - Evaluate documentation against ALCOA and ALCOA+ principles to ensure data integrity standards are maintained. - Identify missing documentation, inconsistencies, protocol deviations, transcription errors, and potential GCP concerns. - Complete standardized QC Checklists to ensure consistency across studies and sites. - Document findings thoroughly and objectively within designated tracking systems. - Escalate significant quality findings according to established procedures. - Collaborate with site personnel to communicate findings and support timely resolution. - Monitor corrective actions and follow-up activities as assigned. - Support continuous improvement initiatives designed to enhance quality and inspection readiness across the organization. - Maintain confidentiality and adhere to all client and UniTriTeam policies and procedures. Qualifications - Associate's degree or Bachelor's degree in a healthcare, life sciences, nursing, or related field preferred. - Equivalent clinical research experience may be considered in lieu of formal education. - Minimum three (3) years of clinical research experience required. - Previous experience as a Clinical Research Coordinator (CRC), Regulatory Specialist, Clinical Research Associate (CRA), or similar clinical research role with direct source documentation responsibilities. - Strong understanding of Good Clinical Practice (ICH-GCP), protocol compliance, protocol deviations, source documentation standards, and ALCOA/ALCOA+ principles. - Previous experience reviewing source documentation required. - Prior experience conducting Quality Control (QC) or Quality Assurance (QA) reviews within clinical research is strongly preferred. - Experience supporting sponsor audits or regulatory inspections is preferred. - Experience with CRIO or other eSource platforms is preferred. Requirements - Extreme attention to detail with the ability to identify even minor discrepancies within clinical documentation. - Strong organizational skills with the ability to prioritize multiple assignments. - Excellent critical thinking and problem-solving abilities. - Ability to interpret study protocols and apply protocol requirements appropriately during reviews. - Strong written and verbal communication skills. - Ability to work independently while maintaining a high level of accuracy and consistency. - Comfortable working within a structured, checklist-driven environment. - Demonstrated commitment to participant safety, data integrity, and quality. Benefits - 100% Remote Opportunity - Work with innovative clients making a difference in healthcare and research. - Join a collaborative and supportive global team environment. - Exposure to a variety of therapeutic areas and research programs. - Opportunities for professional development and continued growth. - Leadership that values transparency, accountability, and communication. - The ability to make a direct impact on the quality and integrity of clinical research.


