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Quality Improvement Nurse (RN) - Work At Home (KY, IN or OH only)
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Louisville, KY Louisville, Kentucky |
About this job
Role: Quality Improvement Nurse (RN) Assignment: Senior Products Location: Work at Home - KY, IN or OH only
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. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. 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. We begin that process by connecting our members with an associate who cares.
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. This is a work at home position, but the ideal candidate will reside in either KY, IN or OH only. T he position may also require frequent day travel throughout the assigned territory with some overnight stays.
In this position, you will execute member/provider quality gap initiatives, medical record retrieval requirements, Chart Chase requests and telephonic outreach initiatives focused on improved HEDIS and patient experience outcomes that are aligned to Quality/Stars goals Other responsibilities include:
Effectively develop, enhance and maintain provider clinical relationship across product lines
Deliver provider/member-specific metrics (e.g., Star Quality Reports (SQR), 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
Extensive Review of 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 an RN
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)
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. 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); and recommended speed for optimal performance from Humana systems if 10Mx1M
Role Desirables
Bachelor's degree in a related field and/or work equivalent
Strong analytic skills and ability to use data to drive improvement activities
Previous clinical or health plan operations experience
Knowledge of Provider Rewards and MRA Coding
Reporting Relationships
This role reports to a Strategic Consultant.
Additional Information
This role will work closely with Market/Region MRA, HSO and Provider Relations Staff.
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.
Interview Format
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.
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. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. 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. We begin that process by connecting our members with an associate who cares.
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. This is a work at home position, but the ideal candidate will reside in either KY, IN or OH only. T he position may also require frequent day travel throughout the assigned territory with some overnight stays.
In this position, you will execute member/provider quality gap initiatives, medical record retrieval requirements, Chart Chase requests and telephonic outreach initiatives focused on improved HEDIS and patient experience outcomes that are aligned to Quality/Stars goals Other responsibilities include:
Effectively develop, enhance and maintain provider clinical relationship across product lines
Deliver provider/member-specific metrics (e.g., Star Quality Reports (SQR), 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
Extensive Review of 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 an RN
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)
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. 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); and recommended speed for optimal performance from Humana systems if 10Mx1M
Role Desirables
Bachelor's degree in a related field and/or work equivalent
Strong analytic skills and ability to use data to drive improvement activities
Previous clinical or health plan operations experience
Knowledge of Provider Rewards and MRA Coding
Reporting Relationships
This role reports to a Strategic Consultant.
Additional Information
This role will work closely with Market/Region MRA, HSO and Provider Relations Staff.
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.
Interview Format
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.