Humana Pensacola, FL, United States
Oct 23, 2017Full time
Role: Quality Improvement Nurse Assignment: Medicaid Quality Improvement Process Location: Pensacola, FL Panhandle area ONLY Assignment Capsule The Quality Improvement Nurse will facilitate and work collaboratively with provider groups focused on Medicaid plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality. Effectively develop, enhance and maintain provider clinical relationship. Deliver provider/member-specific metrics (e.g., HEDIS measures, CMS measures) and coach providers on gap closing opportunities for Humana members 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 Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support 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) Effectively coach provider office staff on best means to communicate with Medicaid members to improve engagement Role Essentials Experienced clinical background as RN Strong knowledge of HEDIS 2 year prior quality experience in a medical office or hospital Strong analytic skills and ability to use data to drive improvement activities 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) Role Desirables Knowledge of Stars and CMS Knowledge of Provider Rewards and MRA Coding Previous clinical or health plan operations experience Previous utilization management, hospital or physician office practice experience Reporting Relationships This role reports to the Quality Improvement Front Line Leader. Additional Information This role may consider a screening for TB. This role will work closely with Health Services and Provider Relations Staff. Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.