RN-HEDIS Quality Operations and Accreditation Nurse - Variable Staffing Pool-Nationwide

Role: RN - Quality Operations Compliance and Accreditation -(Variable Staffing Pool)
Assignment: Market Quality Operations
Location: Work at Home or local Market Office-Nationwide
Humana?s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Humana?s Perfect Service? means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully.
Assignment Capsule
Be a part of our Clinical Space ? as a RN-Quality Operations Compliance and Accreditation Nurse you will engage our members to develop lifelong wellbeing and health.
As a RN-Quality Operations Compliance and Accreditation Nurse, you will collaborate with other Humana departments and our network providers as it relates to Quality of care concerns as well as participate in activities associated with HEDIS, CAHPS, CMS, NCQA and any other compliance requirements for the Health Plan. Other responsibilities include:
Address any quality of care concerns for our members in the assigned territory : Research and investigation of member dissatisfactions/complaints for quality of care.
Recommend actions for Humana Plan providers which would have a positive effect on their HEDIS and CAHPS scores.
Identify and recommend alternatives, if appropriate, for our providers as they deliver care to Humana members.
Conduct clinical studies when appropriate, to identify trends of care.
Become known as a positive representative as well as a resource for our providers and when appropriate, our members for Humana Health Plans.
This role is a VSP: Variable Staffing Pool are Associates who work flexible hours to meet business needs, with no guaranteed minimum or maximum number of hours in any week.
Key Competencies
Builds Trust : Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.
Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Customer Focus : Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.
Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
Role Essentials
Active unrestricted RN license
Ability to be licensed in multiple states without restrictions.
Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
Ability to work independently under general instructions and with a team.
Valid driver's license and/or dependable transportation necessary.
Excellent computer skills and knowledge of Microsoft Word, Excel and Access
Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test
Role Desirables
Education: BSN or Bachelor?s degree in a related field
Medical record reviews for Quality of Care issues
Knowledge of HEDIS specifications and data collection
Previous Medicare/Commercial Health Plan experience
Previous experience in quality or utilization management
Bilingual is a plus
Additional Information
Humana is an organization with careers that change lives?including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you?re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
The following policy applies ONLY to associates working in the state of Arizona:
Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.
Job Clinical Innovations and Health Practitioners
Title: RN-HEDIS Quality Operations and Accreditation Nurse - Variable Staffing Pool-Nationwide
Location: KY-Louisville
Other Locations: US-New Jersey-Livingston, US-Illinois-Chicago, US-IN-Indianapolis, US-Pennsylvania-Philadelphia, US-WI-Green Bay, US-North Carolina-Charlotte, US-Montana-Billings, US-Vermont-Montpelier, US-AL-Mobile, US-New Mexico-Albuquerque, US-Missouri-Kansas City, US-Iowa-Davenport, US-Michigan-Troy, US-South Dakota-Aberdeen, US-Maine-Portland, US-GA-Atlanta, US-CA-Los Angeles, US-West Virginia-Charleston, US-AZ-Phoenix, US-NV-Las Vegas, US-FL-Tampa, US-Rhode Island-Newport, US-New York-New York, US-TN-Chattanooga, US-Delaware-Dover, US-Colorado-Colorado Springs, US-OH-Canton, US-Connecticut-Bridgeport, US-Nebraska-Omaha, US-AR-Bentonville, US-Louisiana-New Orleans, US-Utah-Salt Lake City, US-DC-Washington, US-Oklahoma-Tulsa, US-Maryland-Baltimore, US-Minnesota-Fairmont, US-South Carolina-Lancaster, US-Idaho-Meridian, US-Washington-Seattle, US-Kansas-Kansas City, US-North Dakota-Fargo, US-New Hampshire-Portsmouth, US-Mississippi-Ridgeland, US-Texas-Austin, US-Oregon-Salem, US-Massachusetts-Boston, US-Wyoming-Riverton
Requisition ID: 165993 eb839594731e455fb892634ff8df9b27

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