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This position was posted on July 10, 2026 and is likely no longer accepting applications. We've kept it here for historical reference. Check out the similar jobs below!
Job Overview
Location
Remote Nationwide
Job Type
Full-time
Category
HR & Recruiting
Date Posted
July 10, 2026
Full Job Description
đź“‹ 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.
- • Key responsibilities for the Nurse Clinical Lead include the following:
- • 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.
🎯 Requirements
- • 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
🏖️ Benefits
- • Competitive benefits that support whole-person well-being
- • 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
- • Bonus incentive plan
Skills & Technologies
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About Humana Inc.
Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.
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