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in Miramar, FL
RN - Quality Improvement Nurse - Miramar, FL - Full-time / Part-time
•30 days ago
Hours | Full-time, Part-time |
---|---|
Location | miramar, Florida |
About this job
Role: Quality Improvement Nurse Assignment: Senior Products Location: Miramar, FL (travel to Broward Co / Palm Beach)
Assignment Capsule The Quality Improvement Nurse will facilitate and work collaboratively with provider groups focused on Senior Products, Medicaid and Commercial plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality.
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)
Work collaboratively with Humana's internal departments locally and nationally in support of providers and groups Role Essentials
Experienced clinical background as RN
Strong analytic skills and ability to use data to drive improvement activities
Previous utilization management, hospital or physician office practice experience
Previous experience and/or knowledge of Quality Improvement or process improvement
Strong knowledge of HEDIS/CMS Stars/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)
Role Desirables
Knowledge of Medicare Risk Adjustment and billing/coding
Previous clinical or health plan operations experience
Reporting Relationships
This role reports to the department leader
Additional Information
This role will work closely with the Market/Region Medicare Risk Adjustment, Health Services Organization, and Provider Relations
Assignment Capsule The Quality Improvement Nurse will facilitate and work collaboratively with provider groups focused on Senior Products, Medicaid and Commercial plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality.
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)
Work collaboratively with Humana's internal departments locally and nationally in support of providers and groups Role Essentials
Experienced clinical background as RN
Strong analytic skills and ability to use data to drive improvement activities
Previous utilization management, hospital or physician office practice experience
Previous experience and/or knowledge of Quality Improvement or process improvement
Strong knowledge of HEDIS/CMS Stars/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)
Role Desirables
Knowledge of Medicare Risk Adjustment and billing/coding
Previous clinical or health plan operations experience
Reporting Relationships
This role reports to the department leader
Additional Information
This role will work closely with the Market/Region Medicare Risk Adjustment, Health Services Organization, and Provider Relations