RN or LPN - Quality Improvement Nurse Consultant - New York City - Full-time / Part-time

Role: Quality Improvement Nurse Consultant

Assignment: Medicare

Location: New York - Must live in NYC or surrounding area

At Humana, we want to inspire people to live life fully by awakening them to the right choices for themselves and each other. As the healthcare industry changes and evolves, we’re changing too. We’re growing and re-shaping to become an organization that is committed to helping people achieve lifelong well-being. Humana is an organization where change is constant, and we always have our consumers in mind. We’re known as an innovator in our industry, with a history of being out front of where healthcare needs to go. We need people with a passion for helping others and making change happen. We don’t want to be like everyone else in the industry—we want to be better. And we’re looking for talent that wants to grow, be challenged and inspired to help make that happen.

Assignment Capsule

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

This will be a market facing position, working from home traveling to provider offices on a regular and ongoing basis in an assigned market territory to go over reports to address and to close gaps in care based principally on HEDIS data. This position requires mostly local travel in their assigned territory estimated to be at least 50% of the time. There will also be required attendance for internal meetings and training on an interval basis as determined necessary by their supervisors. Assigned territory will be the 5 boroughs of New York City with occasional travel as far north as the Albany suburbs.

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)

Key Competencies

Builds Trust : Consistently models and inspires high levels of integrity in decisions, speech, and actions. Lives up to commitments, taking responsibility for the impact of one's actions. Exercises the courage to prioritize principles and values over personal or professional gain.

Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same. Employs focus, attention to detail, reliability, and appropriate prioritization to drive outcomes. Sees opportunities to contribute and takes the initiative to create solutions.

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. Develops and strengthens networks and relationships, both inside and outside the organization, that support company performance. Proactively and transparently contributes information and energy toward creating value with others.

Executes for Results : Effectively leverages resources to create exceptional outcomes. Determines the best course of action when facing ambiguity. Anticipates and constructively resolves barriers and constraints. Embraces change, applies new knowledge and reconfigures quickly to capitalize on opportunities. Role Essentials

Experienced clinical background as RN or LPN

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

Previous physician office practice experience, primary care experience or provider visit experience

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

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.

Role Desirables

Strong knowledge of HEDIS/Stars/CMS/Quality

Knowledge of Provider Rewards and MRA Coding

Previous clinical or health plan operations experience

Managed Care Experience

Previous Utilization Review or Case Management experience

Reporting Relationships

You will report to a Director of Quality. This area is under the leadership of the SVP & Chief Operations Officer.

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.