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Quality Improvement Nurse - Central Florida - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Kissimmee, Florida |
About this job
Role: Quality Improvement Clinical Advisor - QIN (Counties: Osceola, Orange, Seminole ) Assignment: Medicare
Location: Field and Work-at-Home - Must live in Orange County to touch down at Corporate office
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/Clinical Advisor will facilitate and work collaboratively with provider groups focused on Medicare Senior Products to guide, recommend and develop practice specific strategies designed to improve all aspects of quality. The QIN will also lead the clinical operation of specific quality initiatives that will improve the management of chronic conditions.
Proactive & effective team approach with other CarePlus Departments.
Effectively develop, enhance and maintain provider clinical relationship across product lines
Deliver provider/member-specific metrics and coach providers on gap closing opportunities for CarePlus members
Successfully promote patients' participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement
Accurately define gaps in CarePlus'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 to 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/support provider office staff on best practices to communicate with Senior patients that may have hearing, vision, physical abilities challenges (i.e. Perfect Service orientation)
To lead clinical initiatives supporting patients and providers to effectively manage their chronic diseases.
Key Competencies
Builds Trust : Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.
Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Customer Focus : Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.
Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. Role Essentials
RN or LPN with a clinical background or previous health plan knowledge
Strong analytic skills and ability to use data to drive improvement activities
Strong communication, interpersonal and negotiation skills
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)
Willing to travel within the Assigned market.
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
Knowledge of Provider Rewards and MRA Coding
Previous clinical or health plan operations experience
BSN or Bachelor's degree in a related field.
Prior Medicare or Medicaid experience.
Knowledge of HEDIS/Stars/CMS/Quality
Previous quality or process improvement experience in a hospital, health plan or physician office practice
Previous experience and/or knowledge of Quality Improvement or process improvement
Bi-lingual preferred
Additional Information
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.
Location: Field and Work-at-Home - Must live in Orange County to touch down at Corporate office
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/Clinical Advisor will facilitate and work collaboratively with provider groups focused on Medicare Senior Products to guide, recommend and develop practice specific strategies designed to improve all aspects of quality. The QIN will also lead the clinical operation of specific quality initiatives that will improve the management of chronic conditions.
Proactive & effective team approach with other CarePlus Departments.
Effectively develop, enhance and maintain provider clinical relationship across product lines
Deliver provider/member-specific metrics and coach providers on gap closing opportunities for CarePlus members
Successfully promote patients' participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement
Accurately define gaps in CarePlus'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 to 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/support provider office staff on best practices to communicate with Senior patients that may have hearing, vision, physical abilities challenges (i.e. Perfect Service orientation)
To lead clinical initiatives supporting patients and providers to effectively manage their chronic diseases.
Key Competencies
Builds Trust : Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.
Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Customer Focus : Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.
Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. Role Essentials
RN or LPN with a clinical background or previous health plan knowledge
Strong analytic skills and ability to use data to drive improvement activities
Strong communication, interpersonal and negotiation skills
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)
Willing to travel within the Assigned market.
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
Knowledge of Provider Rewards and MRA Coding
Previous clinical or health plan operations experience
BSN or Bachelor's degree in a related field.
Prior Medicare or Medicaid experience.
Knowledge of HEDIS/Stars/CMS/Quality
Previous quality or process improvement experience in a hospital, health plan or physician office practice
Previous experience and/or knowledge of Quality Improvement or process improvement
Bi-lingual preferred
Additional Information
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.
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