Remote Quality Compliance Registered Nurse Professional

Location:Metairie, LA
Location Type: Metairie – Remote
Schedule: Full_time
Req: R-312966

Description

Humana Healthy Horizons in Louisiana is seeking Quality Compliance Nurse Professionals who will monitor performance metrics and participate in quality improvement projects for Louisiana (LA) Medicaid. They will lead provider medical record documentation review audits, and participates in multidisciplinary committees, both external and internal.  Understands department, segment, organizational strategy and operating objectives, including their linkages to related areas.  Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Responsibilities

The Quality Compliance Nurse Professional 2 will provide support to the Louisiana market quality improvement activities.

• Uses quality improvement methodology to analyze data and working collaboratively with teams to improve quality for LA Medicaid members.
• Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals.
• Supports the quality improvement plans for both performance and focus HEDIS measures, and other measures as defined by various monitoring activities (i.e. CAHPS).
• Monitors and reports progress towards goals for performance and focus measures.
• Completes reports (including State Reports and Louisiana Medicaid Quality reports).
• Leads quarterly medical record documentation review audits and identifies outliers.
• Participates in multidisciplinary committees, both internal and external.
• Supports annual quality document updates (example: quality improvement program description and evaluation).
• Follows established guidelines/procedures.
• Other activities as assigned.

Required Qualifications

• Must reside in the state of Louisiana  
• An active, unrestricted Registered Nurse (RN) license in the state of Louisiana.
• 2 years of experience in Quality Improvement OR Quality Operations OR Clinical Operations.
• Understanding of healthcare quality measures (example HEDIS, CAHPS).
• Intermediate to advance experience in Microsoft Office programs specifically, Word, PowerPoint and Excel (experienced with pivot tables/filtering, charts, formulas).

Work at Home Requirements

• 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

Preferred Qualifications

• Certified Professional in Healthcare Quality (CPHQ).
• Quality improvement experience with the Medicaid population.

Additional Information

• Workstyle:  Remote.
• Travel: Up to 10% in-state travel to team/member engagement meetings.
• Workdays/Hours: Monday – Friday; 8:00am – 5:00pm CST.
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes; 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more…..
• Vaccination Statement: Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Interview Format

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 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.

Additional information

Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

Social Security Task

Alert: Humana values personal identity protection.  Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.  When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

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Scheduled Weekly Hours

40