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Quality Improvement Nurse (HEDIS), RN or LPN - Houston, TX - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Houston, TX Houston, Texas |
About this job
Role: Quality Improvement Nurse, RN or LPN
Assignment: HEDIS - Medicare
Location: Houston, TX - you must live in this area
This is a work at home role requiring visits to local providers, Mon-Fri, 8am-5pm.
Assignment Capsule
The Quality Improvement Nurse will facilitate and work collaboratively with provider groups focused on Senior Products, Commercial and Medicaid plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality.
Effectively develop, enhance and maintain provider clinical relationship across product lines
Deliver provider/member-specific metrics (e.g., SQR reports, Member on a page, Anvita alerts) and coach providers on gap closing opportunities for Humana members
Successfully promote practice-patients' participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement
Accurately define gaps in Humana's service relationship with providers and facilitate resolution
Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support
Review medical records and identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture, use SQR to identify information and provide guidance to practice)
Effectively coach provider office staff on best means to communicate with Senior members that may have hearing, vision, physical abilities challenges (i.e. Perfect Service orientation)
Role Essentials
Experienced clinical background as RN or LPN
Strong analytic skills and ability to use data to drive improvement activities
Previous utilization management, hospital or physician office practice experience
Previous experience and/or knowledge of Quality Improvement or process improvement
Strong knowledge of HEDIS/Stars/CMS/Quality
Strong organizational and prioritization skills with ability to collaborate with multiple departments
Detail orientated and comfortable working with tight deadlines in a fast paced environment
Ability to work independently under general instructions, self-directed and motivated
Excellent PC skills (including MS Word, Excel and PowerPoint)
If selected for this role, you will be required to be screened for TB.
Valid drivers license and/or dependable transportation necessary (variable by region)
Role Desirables
Bilingual a plus
Knowledge of Provider Rewards and MRA Coding
Previous clinical or health plan operations experience
Additional Information
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Assignment: HEDIS - Medicare
Location: Houston, TX - you must live in this area
This is a work at home role requiring visits to local providers, Mon-Fri, 8am-5pm.
Assignment Capsule
The Quality Improvement Nurse will facilitate and work collaboratively with provider groups focused on Senior Products, Commercial and Medicaid plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality.
Effectively develop, enhance and maintain provider clinical relationship across product lines
Deliver provider/member-specific metrics (e.g., SQR reports, Member on a page, Anvita alerts) and coach providers on gap closing opportunities for Humana members
Successfully promote practice-patients' participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement
Accurately define gaps in Humana's service relationship with providers and facilitate resolution
Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support
Review medical records and identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture, use SQR to identify information and provide guidance to practice)
Effectively coach provider office staff on best means to communicate with Senior members that may have hearing, vision, physical abilities challenges (i.e. Perfect Service orientation)
Role Essentials
Experienced clinical background as RN or LPN
Strong analytic skills and ability to use data to drive improvement activities
Previous utilization management, hospital or physician office practice experience
Previous experience and/or knowledge of Quality Improvement or process improvement
Strong knowledge of HEDIS/Stars/CMS/Quality
Strong organizational and prioritization skills with ability to collaborate with multiple departments
Detail orientated and comfortable working with tight deadlines in a fast paced environment
Ability to work independently under general instructions, self-directed and motivated
Excellent PC skills (including MS Word, Excel and PowerPoint)
If selected for this role, you will be required to be screened for TB.
Valid drivers license and/or dependable transportation necessary (variable by region)
Role Desirables
Bilingual a plus
Knowledge of Provider Rewards and MRA Coding
Previous clinical or health plan operations experience
Additional Information
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
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