Clinical Care Nurse - FL

Become a part of our caring community as a clinic-based nursing role focused on improving patient outcomes. You will support safe Transitions of Care (TOC), reduce avoidable ED utilization, and drive Medicare Advantage Stars and quality performance. Clinic locations are available in Florida – Tamarac.

About the Role

The Clinical Care RN plays a critical role in advancing clinical quality and supporting patients across transitions of care. You will contribute to Medicare Advantage Stars ratings by proactively identifying care opportunities, engaging patients and providers, and driving evidence-based interventions. The role balances direct patient education and outreach with data-driven quality improvement efforts, aligning daily responsibilities with organizational values such as 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 value-based populations.
• Population Health: Deliver culturally appropriate chronic disease education to activate patients in chronic disease self-management, particularly in DM, HTN, CHF, and COPD.

Responsibilities

• Analyze clinical data and trends from platforms such as Athena EMR and DataHub to identify gaps in care related to Stars and HEDIS measures, Transitions of Care, and post-hospitalization needs, prioritizing high-impact opportunities.
• Proactively identify recently discharged inpatient, observation, and emergency department patients and coordinate timely post-discharge follow-up in alignment with TOC and Transitional Care Management (TCM) requirements to address root causes of utilization and 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. Identify and escalate barriers, collaborating with providers and 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.
• Prepare, participate, and discuss patients in center huddles and high-risk rounds with providers and the center-based and interdisciplinary team.
• Participate 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 Transitional Care Management goals, proactively 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 in-person engagement for Stars care opportunity closures.
• Maintain patient confidentiality in accordance with HIPAA.
• Document patient encounters accurately and timely in the indicated platform (e.g., medical record).
• Follow organizational policies related to safety, infection control, and attendance.
• Perform other duties as assigned.

Requirements

• Must meet one of the following requirements: Associate's degree in nursing (ADN) or Bachelor's degree in nursing (BSN).
• Active, unrestricted RN license in the State of Florida.
• 3+ years' 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), data analytics tools (e.g., DataHub, Compass Rose, SalesForce HealthCloud), and 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.
• 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.
• Bilingual in English and Spanish with full professional proficiency (strong preference).
• Basic Life Support trained.

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.

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: Must reside in designated market area, in reasonable commutable distance to assigned clinic(s).
• Hours: Monday–Friday, 8:00 AM–5:00 PM; additional time may be required.

This role is considered patient-facing and requires Tuberculosis (TB) screening. If selected, you will be required to be screened for TB.

This role requires a valid state driver's license and maintenance of personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event/$10,000 for property damage, whichever is higher.

Pay

The pay range for this full-time (40 hours per week) position is $71,100 - $97,800 per year. The range may be higher or lower based on geographic location, and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, and certifications. This role is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive benefits that support whole-person well-being, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.

About Us

Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, and minor injury treatment. As part of Humana’s Primary Care Organization, Conviva’s innovative, value-based approach ensures patients receive the best care when needed most and at the lowest cost. We address the social, emotional, behavioral, and financial needs that impact well-being.

CenterWell, a Humana company, is a leading healthcare services business focused on creating integrated and differentiated experiences that prioritize patients. CenterWell is the largest provider of senior-focused primary care and a leader in home healthcare, integrated home delivery, specialty pharmacy, hospice, and retail pharmacy. CenterWell is part of Humana Inc. (NYSE: HUM).