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Hours Full-time, Part-time
Location Albany, NY
Albany, New York

About this job

Role: HEDIS Quality Nurse, VSP (Variable Staffing Pool)

Assignment: Market Quality Operations

Location: Work from Home anywhere

Humana's dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Humana's Perfect Service means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully.

Assignment Capsule

Be a part of our Clinical Space -- as a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.

As a HEDIS Quality Nurse you will collaborate with other Humana departments and our network providers as it relates to participation in activities associated with HEDIS, CAHPS, CMS, NCQA and any other compliance requirements for the Health Plan. Other responsibilities include:

Collection, abstraction and research of annual HEDIS data. May include HEDIS on-site chart reviews.

Recommend actions for Humana Plan providers which would have a positive effect on their HEDIS and CAHPS scores.

Participate in special projects including participation in work groups and/or task forces may include but are not limited to coordination of continuity of care, HEDIS coordination, CAHPS, community outreach and partnerships, etc.

This role is a VSP: Variable Staffing Pool are Associates who work flexible hours to meet business needs, with no guaranteed minimum or maximum number of hours in any week.

Key Competencies

Builds Trust : Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.

Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same.

Customer Focus : Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.

Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. Role Essentials

Active unrestricted RN license

Minimum of 5 years or more of prior clinical experience

Strong computer skills and knowledge of Microsoft Word, Outlook and Excel

Ability to work independently under general instructions and with a team.

Valid driver's license and/or dependable transportation necessary.

Role Desirables

Prior HEDIS experience or knowledge of HEDIS specifications and data collection

Prior auditing experience

Education: BSN or Bachelor's degree in a related field

Medical record reviews for Quality of Care issues

Previous Medicare, Medicaid/Commercial Health Plan experience

Previous experience in quality or utilization management

Additional Information

Humana is an organization with careers that change lives---including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Apply now, or join our Talent Network so you can stay informed and up to date on what's happening at Humana.