The job below is no longer available.

You might also like

in Fort Myers, FL

Use left and right arrow keys to navigate
Hours Full-time, Part-time
Location Fort Myers, FL
Fort Myers, Florida

About this job

Role: Quality Improvement Nurse -- RN or LPN

Assignment: Transcend - a wholly owned subsidiary of Humana

Location: Fort Myers, Florida

This is a Work-At-Home opportunity for candidates located in the Fort Myers, FL and surrounding areas only

We help doctors do what they do best while engaging patients in their care

At Transcend we recognize the need to simplify population health management for the people who provide health care. We support physicians and care teams, provider groups and integrated delivery systems with practical onsite services and solutions that help practices shift from a health care system built on treatment transactions to a value-based model built on better outcomes for patients more engaged as partners in their own care.

Role Description

At Transcend Population Health Management LLC, we deliver population health care and financial risk management, clinical-integration technology, and physician engagement services to health care providers through a captive Independent Physician Association model. Transcend leaders and market teams work onsite at physician practices to provide operational and medical management infrastructure support, patient outreach and medical records management. We also offer customized, intuitive technology that makes the administrative side of value-based care easier for physicians and their teams.

As a Quality RN, you will work collaboratively with providers to focus on chronic/complex care members as related to HEDIS and Risk Adjustment measures to come up with solutions to improve member outcomes. The Quality RN will focus on Senior Product plans to guide, recommend and develop practice specific strategies designed to improve HEDIS scores and all aspects of quality.

Primary responsibilities include:

Develop, facilitate, and/or secure opportunities to positively impact Triple Aim (cost/quality/documentation)

Ensure quality goals are aligned and executed effectively

Provide resources, educates and coaches provider practices on Quality Improvement

Assess and leverage provider technology to promote prospective and retrospective medical record abstraction

Oversees HEDIS reporting and trend to identify opportunities for quality improvement

Partners with cross-functional teams, including, Sr. Product/health plan Quality Management to encourage member participation in population health

Drives STAR measures: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Outcome Surveys (HOS), Care Management Services (CMS) and Healthcare Effectiveness Data Information Sets (HEDIS)

Role Essentials

Active RN or LPN license in the state(s) in which the nurse is required to practice

Ability to be licensed in multiple states without restrictions

Clinical experience in a healthcare setting combined with quality improvement and administrative background

Experience working with Core Measures, HEDIS, HOS and/or CAHPS surveys, JCAHO, NCQA, CMS or other regulatory guidelines

Strong communication skills; ability to develop and foster relationships

Ability to work independently under general instructions and with a team

Valid driver's license

Ability to travel to local provider offices 3-4 days a week in the Ft. Meyers and surrounding areas (will also assist with other markets as needed)

High level of proficiency with MS Products, specifically Outlook and Excel as well as experience with EMRs and aptitude to learn clinical systems

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

If selected for this role, you will be required to complete and pass background check/investigation for AHCA compliance

Role Desirables

* BSN or Bachelor's degree

* Health Plan or provider practice quality experience

* Previous Medicare and Medicaid experience

* Previous experience in quality management; population health management is a plus

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 for 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 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 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

For more information about Transcend, please visit www.TranscendPHM.com .