The job below is no longer available.

You might also like

in Miramar, FL

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

About this job

Role: Quality, Compliance and Accreditation - Clinical Advisor RN

Assignment: Market Quality Operations

Location: Miramar, FL

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

Be a part of our Clinical Space -- as a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.

Humana is seeking a Quality, Compliance and Accreditation - Clinical RN, who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.

Participates in collection and review of annual HEDIS data. Participates in annual planning sessions. Act as a HEDIS Coordinator, Researcher, Reviewer and/or Auditor, as needed.

Participate in required audits to meet all accreditation and regulatory requirements. Implementation of corrective action plans. Assist with survey preparation and participate with survey process as needed.

Conduct Medical Record Reviews and coordination and continuity of care studies.

Participate in work groups and/or task forces that may include but are not limited to analysis and improvement activities, community outreach and partnerships, investigation of provider performance improvement inquiries and other state/Region projects.

Review potential quality of care issues following prescribed guidelines and implementation of appropriate/timely actions.

Participate in Quality Management/Peer Review/Florida Medicaid Quality Improvement Committee meetings.

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

Active RN license in the state of Florida

Ability to be licensed in multiple states without restrictions

Minimum of two years of prior clinical experience in any area, but preferably in an acute care, skilled or rehabilitation clinical setting

Ability to work independently under general instructions and with a team

Valid drivers license and/or dependable transportation necessary

Proficient in the use of MS Office (Word, Excel, & PowerPoint)

Must be able to travel 25%

Role Desirables

HEDIS experience

Education: BSN or Bachelor's degree in a related field

Managed care experience

Health Plan experience

Previous Medicare/Medicaid Experience a plus

Documented experience with tasks/projects requiring detail oriented focus

Experience with CGX, CCP2, and QMS

Bilingual is a plus

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.

Apply now, or join our Talent Network so you can stay informed and up to date on what's happening at Humana.