Quality Improvement Specialist

6 days 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.

Job Summary

We are 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/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:
    • Participation 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%

This job is eligible for a bonus incentive plan.

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



  • Atlanta, Georgia, United States Gateway Foundation Full time

    Quality Improvement SpecialistGateway Foundation is seeking a Quality Improvement Specialist to join our team. As a Quality Improvement Specialist, you will be responsible for ensuring the highest quality of care for our clients. This includes conducting site visits, reviewing client records, and evaluating the adequacy and appropriateness of care in...


  • Atlanta, Georgia, United States Northside Hospital Full time

    Quality Improvement Specialist RNNorthside Hospital is a leading healthcare provider in Atlanta, committed to delivering exceptional patient care and advancing the quality of our services. As a Quality Improvement Specialist RN, you will play a vital role in driving our continuous quality improvement initiatives and ensuring compliance with regulatory...


  • Atlanta, Georgia, United States Northside Hospital Full time

    Quality Improvement Specialist RNNorthside Hospital is a leading healthcare provider in Atlanta, committed to delivering exceptional patient care and advancing the quality of our services. As a Quality Improvement Specialist RN, you will play a vital role in driving our continuous quality improvement initiatives and ensuring compliance with regulatory...


  • Atlanta, Georgia, United States Northside Hospital Full time

    About the RoleNorthside Hospital is a leading healthcare provider, renowned for its cutting-edge facilities and commitment to excellence. As a Quality Improvement Specialist, RN, you will play a vital role in enhancing the quality and reach of our care, driving innovation and growth in the Atlanta and beyond.Key ResponsibilitiesQuality Improvement Expertise:...


  • Atlanta, Georgia, United States Northside Hospital Full time

    About the RoleNorthside Hospital is a leading healthcare provider in Atlanta, committed to delivering exceptional patient care and advancing the quality of healthcare in our community.This role is a key part of our quality improvement efforts, working closely with hospital staff and medical teams to identify areas for improvement and implement evidence-based...


  • Atlanta, Georgia, United States Northside Hospital Full time

    Northside Hospital is a leading healthcare provider in Atlanta, committed to delivering exceptional patient care and advancing the quality of healthcare in the community. We are seeking a skilled Nurse Practitioner to join our Quality Improvement team, playing a vital role in ensuring accurate and comprehensive clinical documentation, developing quality...


  • Atlanta, Georgia, United States Northside Hospital Full time

    Job Opportunity at Northside HospitalNorthside Hospital is a leading healthcare provider in Atlanta, committed to delivering exceptional patient care and advancing the quality of healthcare services. We are seeking a highly skilled Quality Improvement Performance Coordinator to join our team.Key Responsibilities:Provide expert guidance on quality improvement...


  • Atlanta, Georgia, United States Northside Hospital Full time

    About the RoleNorthside Hospital is a leading healthcare provider, renowned for its cutting-edge facilities and commitment to excellence. As a System Quality and Accreditation Coordinator, you will play a vital role in ensuring the highest standards of quality and patient care across our network of care locations.Key ResponsibilitiesQuality and Accreditation...


  • Atlanta, Georgia, United States Sonder Health Plans Full time

    Job SummaryWe are seeking a highly skilled Quality Improvement Manager to join our team at Sonder Health Plans. As a key member of our organization, you will be responsible for driving quality improvement initiatives and ensuring compliance with regulatory and accreditation requirements.Key ResponsibilitiesQuality Improvement Initiatives: Develop and...


  • Atlanta, Georgia, United States Humana Full time

    Quality Improvement Professional 2 Job DescriptionBecome 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...

  • Nurse Practitioner

    2 weeks ago


    Atlanta, Georgia, United States Northside Hospital Full time

    Quality Improvement Nurse PractitionerNorthside Hospital is a leading healthcare provider in Atlanta, renowned for its cutting-edge facilities and commitment to excellence. As a Quality Improvement Nurse Practitioner, you will play a vital role in enhancing the quality of care delivered to our patients and communities.The successful candidate will be...


  • Atlanta, Georgia, United States Grady Health System Full time

    Job Title: Emergency Quality SpecialistGrady Health System is seeking a highly skilled Emergency Quality Specialist to join our team.Job SummaryThe Emergency Quality Specialist is responsible for creating, managing, and evaluating education/training programs and services in the Emergency Department. This role requires a strong understanding of cognitive,...


  • Atlanta, Georgia, United States Northside Hospital Full time

    Job SummaryNorthside Hospital is a leading healthcare provider, renowned for its commitment to excellence and innovation. As a Quality Improvement Performance Coordinator, you will play a vital role in driving continuous quality improvement throughout the organization.Key ResponsibilitiesAs a Quality Improvement Performance Coordinator, you will:Prepare and...

  • Quality Manager

    2 days ago


    Atlanta, Georgia, United States Infosys McCamish Systems Full time

    Job DescriptionJob Title: Quality Manager - Process ImprovementLocation: Atlanta, GAJob Type: Full TimeJob Summary:We are seeking a highly skilled Quality Manager - Process Improvement to join our team at Infosys McCamish Systems. The successful candidate will be responsible for driving process improvement, ensuring process compliance, and implementing,...

  • Nurse Practitioner

    3 weeks ago


    Atlanta, Georgia, United States Northside Hospital Full time

    Northside Hospital is a leading healthcare provider in Atlanta, renowned for its cutting-edge facilities and commitment to excellence. As a Quality Improvement Nurse Practitioner, you will play a vital role in enhancing the quality of care delivered to our patients and communities. Your expertise will be instrumental in developing and implementing quality...


  • Atlanta, Georgia, United States Channel Personnel Services Full time

    Job SummaryWe are seeking a highly skilled Continuous Improvement Specialist to join our team at Channel Personnel Services. As a key member of our organization, you will be responsible for leading plant-wide and department-level performance improvement initiatives that positively impact cost, quality, safety, material flow, productivity, and delivery...

  • Nurse Practitioner

    3 weeks ago


    Atlanta, Georgia, United States Northside Hospital Full time

    Northside Hospital is a leading healthcare provider in Atlanta, renowned for its cutting-edge facilities and commitment to excellence. As a Quality Improvement Nurse Practitioner, you will play a vital role in enhancing the quality of care delivered to our patients and communities. Your expertise will be instrumental in developing and implementing quality...

  • Nurse Practitioner

    3 weeks ago


    Atlanta, Georgia, United States Northside Hospital Full time

    Northside Hospital is a leading healthcare provider in Atlanta, renowned for its cutting-edge facilities and commitment to excellence. As a Quality Improvement Nurse Practitioner, you will play a vital role in enhancing the quality of care delivered to our patients and communities. Your expertise will be instrumental in developing and implementing quality...


  • Atlanta, Georgia, United States Humana Full time

    Quality Improvement Professional 2 Job DescriptionHumana is seeking a Quality Improvement Professional 2 who will implement the Health Plan's QI Program.Key Responsibilities:Participate in required audits to meet accreditation and regulatory requirements.Participate with corrective action plans.Assist with survey preparation, committee preparation,...


  • Atlanta, Georgia, United States Actalent Full time

    Job Title: HEDIS Quality Improvement AbstractorWe are seeking a highly skilled HEDIS Quality Improvement Abstractor to join our team at Actalent. As a key member of our quality improvement team, you will be responsible for leading data collection and abstraction for our company's quality measures, including HEDIS, CMS, CHIPRA, and other custom...