Role: Quality Improvement Nurse Consultant, RN
Assignment: Medicare Location: Albuquerque, NM (Northern NM territory
Looking for the right candidate who has a strong sense of community and knowledge of the Northern New Mexico area. The Quality Improvement Nurse Consultant works as part of an interdepartmental team of around 5 members (POD), working collaboratively with providers. Focus of work is to help providers with HEDIS measures and improve the quality of care received by the member. The POD/team will work collaboratively with provider groups focused on Senior Product plans to guide, recommend and develop practice specific strategies designed to improve HEDIS scores and all aspects of quality. Primary responsibilities include: * Qualify, prioritize, and concentrate Provider visit efforts on top opportunities
Develop, facilitate, and/or secure opportunities to positively impact Triple Aim
Maintain client relationships, effectively address provider needs & PODS goals
Understand the business, industry, and industry trends and use knowledge to recommend effective solutions.
Lead and/or support collaborative business partnerships, elicit client understanding and insight to advise and make recommendations.
Clarify scope of work commitments and deliverables, and define measurable success criteria to monitor progress toward goals.
Deliver provider specific metrics and coach providers on gap closing opportunities
Facilitate patients’ participation in clinical programs & identify opportunities member participation
Define gaps in Humana’s service relationship with providers and facilitate resolution
Identify specific practice needs where Humana can provide support
Develop, enhance and maintain provider clinical relationship across product lines.
Establish and foster a healthy working relationship between practice and Humana.
Partner with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education.
Provide resources and educational opportunities to provider and staff.
Capture concerns/issues in action plans as agreed upon by Provider & PODS Owner
Document action plans and details of visits and outcomes
Look beyond metrics to identify underlying issues that contribute to gaps.
Prioritize Analyst work for PODS specific reporting.
Accountable for Provider Prioritization & communication of priorities to PODS team.
Assess data, identify opportunities, and understand how the PODS drive successful Triple Aim outcomes.
An active RN license in the designated state
Strong interpersonal & relationship building skills
Strong influencing, listening, and consultative skills
Strong analytical skills, able to utilize Excel and interpret data
Understanding of clinical programs
Organizational and prioritization skills
This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10Mx1M
Bachelor’s degree in a related field
CMS Stars/performance measures/HEDIS knowledge and/or experience
Proven leadership experience
Experience in a state and/or federally regulated health care environment
Strong business acumen to help drive metrics
Utilization management knowledge and/or experience
Provider and member rewards program knowledge and experience Reporting Relationships
This role reports to Director – STARS and Quality Additional Information
At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.
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.
Title: Quality Improvement Nurse Consultant (RN) - Albuquerque, NM (Northern NM territory)
Location: New Mexico-Albuquerque
Requisition ID: 179893
Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.