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in San Antonio, TX

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Hours Full-time, Part-time
Location San Antonio, TX
San Antonio, Texas

About this job

Role: Quality Improvement Nurse

Assignment: Medicare/HEDIS

Location: Waco, TX and surrounding area

This role is Mon-Fri, 8am-5pm and requires travel throughout a territory in the required area. You must live in this area to be considered for this role.

Assignment Capsule

The Quality Improvement Nurse will facilitate and work collaboratively with provider groups focused on Senior Products, Commercial and Medicare plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality.

Critical thinking to prioritize PCP outreach based on what will deliver greatest return on investment (i.e. who to outreach, frequency of outreach, visit focus, communication method / collateral)

Evaluate provider current state willingness to work with Humana to improve Stars performance and tailor messaging accordingly

Identify key point of contact for each prioritized PCP and effectively develop / enhance provider clinical relationship across product lines. Accurately define gaps in Humana's service relationship with providers and facilitate resolution through Service Alignment Manager (SAM)

Deliver provider/member-specific metrics (e.g., SQR reports, Member Experience, Medicare Adherance) and coach providers on gap closing opportunities for Humana members

Educate PCP's on Stars program, changes and best practices to enhance all aspects of Stars performance

Identify provider best practices and needs, disseminate for sharing and / or resolution

Maintain documentation of provider visit, including focus and performance trending (Quality Journal)

Facilitate effective collaboration and communication with workgroup members (including operations, clinical and MRA) and Stars and Quality team members

Identify opportunities to improve Stars and Quality processes, methods, team engagement, etc. and present resolution options / cost

Role Essentials

Experienced clinical background as RN or LPN

History of taking on roles of increased responsibilities with proven results

Self-directed and motivated, with proven ability to work independently given general instructions

Strong communication and public speaking skills; proven influencer

Detail orientated, forward looking and comfortable working with tight deadlines in a fast paced, dynamic environment

Demonstrated proficiency in Word, Excel and PowePoint

If selected for this role, you will be required to be screened for TB.

Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed for optimal performance systems if 10Mx1M.

Role Desirables

Knowledge of CMS Stars Program elements, including HEDIS, Patient Experience and Patient Safety

Physician office practice experience

Previous experience and/or knowledge of Quality Improvement or process improvement

Strong analytic skills and ability to use data to drive improvement activities

Previous Health Insurance clinical or 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.