Location Type: Remote
Additional Location: IN; OH;
The Quality Compliance Nurse (RN) Professional participates in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences.
The Quality Compliance Nurse (RN) Professional participates in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences. This role contributes to multidisciplinary committees, both external and internal, required by NCQA and the State Contract.
The Quality Compliance Nurse (RN) Professional participates in, with potential to lead, Kentucky market quality improvement activities. And understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
- Member outreach calls
- Medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations in collaboration with internal and external stakeholders.
- Provider outreach to close care gaps, audit records to identify improvement opportunities, and abstract data from records to close gaps
- Quality document updates (example: quality improvement program description, work plans, and evaluation)
- Quality Improvement Committee meetings
- Completing and updating reports (including State Reports and Kentucky Medicaid Quality Improvement Committee reports)
- Multidisciplinary committees, both internal and external
- Strong relationship building skills
- Excellent written and oral communication skills
- Ability to work independently under general instructions, must be self-directed and motivated
- Registered Nurse with active Kentucky License with no restrictions
- 3+ years of previous experience working with member outreach on quality and performance improvement activities
- 2+ years previous experience in healthcare quality improvement/quality operations
- Experience with healthcare quality measures (example HEDIS, CAHPS)
- Comprehensive knowledge of Microsoft Office Word, PowerPoint, intermediate Excel experience (pivot tables/filtering, charts, formulas)
- Must reside in KY, OH or IN and must have an active KY RN License
- Certified Professional in Healthcare Quality (CPHQ)
- Quality improvement experience with the Medicaid population
- Project management experience
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
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) 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 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.
LI#Remote Limited Geography Remote – This is a remote position but located within a specific geography.
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