RN Quality Improvement Specialist

2 weeks ago

Atlanta, Georgia, United States Humana Full time
Quality Improvement Professional 2 Job Description

Become a part of our caring community and help us put health first. Humana is seeking a Quality Improvement Professional 2 who will implement the Health Plan's QI Program.

Key Responsibilities:
  • Compliance to Accreditation, State, Federal Regulations:
    • Participate in required audits to meet accreditation and regulatory requirements.
    • Participate with corrective action plans.
    • Assist with survey preparation, committee preparation, presentation, documentation.
  • HEDIS:
    • Collect, research, reviews during annual HEDIS Chart Review season.
    • Participate in strategy, training, planning, implementation meetings.
  • Quality Issues Resolution Process:
    • Review and investigate potential quality issues following established policies and implementation of appropriate/timely actions.
  • Peer Review Committee Process:
    • Assist with and/or attend Peer Review Committee (PRC) activities.
    • Assist with documents to be presented to PRC.
  • Medical Record Documentation Review (MRDR):
    • Review medical records for medical record keeping practices and recommend quality improvements.
  • Special Projects:
    • Participate in work groups/lean projects/task forces, which may include but are not limited to analysis and improvement activities, community outreach and partnerships.
Requirements:
  • Bachelor's degree
  • Reside in FL, GA, NC or SC
  • 3 or more years clinical and/or health plan experience
  • RN active unrestricted compact license or FL license
  • Experience in a fast-paced insurance or healthcare setting
  • Experience in provider relations
  • Understanding of healthcare quality measures STARS, HEDIS, etc.
  • Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint
  • Proven analytical skills
Preferred Qualifications:
  • Knowledge of Humana's internal policies, procedures and systems
  • Experience in quality management
  • Certified Professional in Healthcare Quality (CPHQ)
Additional Information:

Travel- 5%

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.

If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.

Expect this type of interview to last anywhere from 5-10 minutes.

Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work at Home Guidance:

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  • Satellite, cellular and microwave connection can be used only if approved by leadership

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-BB1

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting.

The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$63,400 - $87,400 per yearThis job is eligible for a bonus incentive plan.

This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being.

Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.

Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About CarePlus Health Plans:

CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years.

CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about.

As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.

About Humana:

Humana Inc


(NYSE:

HUM) is committed to putting health first - for our teammates, our customers, and our company.

Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.

These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer


It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status.

It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements.

This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.


Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion.

We also provide free language interpreter services.

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