Quality Improvement Nurse – Team Leader - Huntington, WV
Humana - Charleston, WV

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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)

Key Competencies

Leveraging Technology:
You are technological savvy and know how to appropriately share and use your knowledge to improve business results.

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.

Is Accountable: You meet clearly stated expectations and take responsibility for achieving results.

Clinical Knowledge: You understand clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications of such programs

Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience

Strong interpersonal & relationship building skills


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)


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




Primary Location


US-West Virginia-Charleston



Clinical Innovations and Health Practitioners

Work Environment Type


Virtual/Work At Home



Yes, 75 % of the Time

About this company
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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...