Quality Improvement Nurse - Team Lead
Humana - Metairie, LA

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The Quality Improvement Nurse will facilitate and work collaboratively with provider groups focused on Medicare Senior Products, and Medicaid plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality, cost and documentation.

Deliver provider/member-specific metrics around profit and loss and coach providers on gap closing opportunities for Humana members

Facilitate regular Provider Engagement Strategy team meetings with ability to prioritize and interpret data through the use of strong analytical skills

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

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)

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Key Competencies

Builds Trust: You honor your word by doing what you say you are going to do.

Drives for excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.

Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.

Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

Qualifications

Role Essentials

Experienced clinical background as RN

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

Previous quality or process improvement experience in a hospital or physician office practice

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)

Travel with reliable transportation

Role Desirables

Knowledge of Provider Rewards and MRA Coding

Previous clinical or health plan operations experience

MSN/MBA/BSN or Bachelor’s degree in a related field.

Prior Medicare or Medicaid experience.

Knowledge of HEDIS/Stars/CMS/Quality

Reporting Relationships

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

Additional Information

Schedule

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Full-time

Primary Location

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US-Louisiana-Metairie

Role

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Clinical Innovations and Health Practitioners

Work Environment Type

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Office

Humana - 2 years ago - save job - copy to clipboard
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Humana Inc. (Humana) is a full-service benefits solutions company, offering an array of health and supplemental benefit plans for employer...