HEDIS Quality Operations, Compliance and Accreditation- VSP- Prefer LPN or RN - Full-time / Part-time

Role: HEDIS Quality Operations, Compliance and Accreditation - VSP- prefer RN or LPN Assignment: Market Quality Operations Location: Work at home 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. Assignment Capsule Be a part of our Clinical Space -- as a Clinical Advisor in Quality Operations you will be working to improve the members' lifelong wellbeing and health. Humana is seeking a Quality Operations, Compliance and Accreditation RN. You will collaborate with other Humana departments and our network providers as it relates to Quality activities associated with HEDIS, CAHPS, CMS, NCQA and any other compliance requirements for the Health Plan. As a Quality Nurse you will be responsible for: Address and investigate potential quality issues from our member complaints Contacting providers for records needed for reviews via phone, mail or fax Communicate case findings to a Humana Medical Director Compliance to state, CMS, and federal regulations. Pass HEDIS IRR at 100% after training completed each year Review and Research HEDIS records with accuracy and timely Pass HEDIS MRRV with no major issues found Work flexible hours throughout the HEDIS season as needed Interact with Commercial and Medicare Market leaders, other departments, and the community to promote Humana programs and strategic initiatives. 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. Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first. Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. Role Essentials Active unrestricted professional license Ability to be licensed in multiple states without restrictions. Minimum of 3 years or more of prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting. Ability to work independently under general instructions and with a team. Valid driver's license and/or dependable transportation necessary. Excellent computer skills and knowledge of Microsoft Word, Excel and PowerPoint. Role Desirables RN or LPN license Education: BSN or Bachelor's degree in a related field Medical record reviews for Quality of Care issues Research and investigation of member dissatisfactions/complaints for quality of care Knowledge of HEDIS specifications and data collection Previous Medicare/Commercial Health Plan experience Previous experience in quality or utilization management Bilingual is a plus Additional Information At Humana, we know your well-being is important to you, and it's important to us too. That's why we're committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana. After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what's happening around our organization in the changing world of healthcare.