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Quality, Compliance and Accreditation - Clinical Advisor, RN - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | miramar, Florida |
About this job
Role: Quality, Compliance and Accreditation - Clinical Advisor, RN
Assignment: Quality Operations Compliance & Accreditation
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.
As a Clinical Advisor RN in the Quality Compliance Accreditation Department, you will be responsible to:
Implement the Quality Improvement Program to meet all clinical regulatory and accreditation requirements.
Review medical records for appropriate and timely health care and service. Implement quality improvement plans, when necessary.
Collect and review medical record data (HEDIS) to show compliance and improvement compared to peers.
Analyze clinical data, identify root causes and opportunities for improvement.
Create documentation and clinical studies to submit to regulatory and accrediting bodies.
Participate on teams to develop and implement quality improvement initiatives.
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
Prior clinical experience in a clinical setting for a minimum of two years
Ability to work independently under general instructions and with a team
Basic computer skills and knowledge of Microsoft Word, Excel, etc.
Valid driver's license and/or dependable transportation necessary
Role Desirables
HEDIS experience
Education: BSN or Bachelors degree in a related field
Managed healthcare experience
Certification in quality
Previous Medicare/Medicaid Experience a plus
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.
Assignment: Quality Operations Compliance & Accreditation
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.
As a Clinical Advisor RN in the Quality Compliance Accreditation Department, you will be responsible to:
Implement the Quality Improvement Program to meet all clinical regulatory and accreditation requirements.
Review medical records for appropriate and timely health care and service. Implement quality improvement plans, when necessary.
Collect and review medical record data (HEDIS) to show compliance and improvement compared to peers.
Analyze clinical data, identify root causes and opportunities for improvement.
Create documentation and clinical studies to submit to regulatory and accrediting bodies.
Participate on teams to develop and implement quality improvement initiatives.
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
Prior clinical experience in a clinical setting for a minimum of two years
Ability to work independently under general instructions and with a team
Basic computer skills and knowledge of Microsoft Word, Excel, etc.
Valid driver's license and/or dependable transportation necessary
Role Desirables
HEDIS experience
Education: BSN or Bachelors degree in a related field
Managed healthcare experience
Certification in quality
Previous Medicare/Medicaid Experience a plus
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.