Humana Quality Improvement RN - Richmond, VA in Glen Allen, Virginia

Role: RN Quality Improvement Consultant

Assignment:Medicare/HEDIS

Location:Richmond, VA

The hours of this role are Mon-Fri, 8am-5pm. You must live in the Richmond area to be able to visit local providers as needed.

Assignment Capsule

Be a part of our Clinical Team – as a Clinical Quality Consultant you will engage and collaborate with our health care providers to enable our members to develop lifelong wellbeing and health by identifying opportunities to enhance care delivery:

  • Participate in internal Provider Engagement team’s strategy/planning meetings

  • Consult with internal resources to identify opportunities for improving provider/member outcomes as related to gaps in quality care and/or disease management program participation

  • Facilitate discussions with provider practice resources on improvement opportunities, plan and partner on improvement initiatives, and monitor outcomes

  • Facilitate the engagement of members in Humana’s clinical programs by educating, promoting and supporting provider practice resources in these efforts

  • Other duties as assigned

Role Essentials

  • Active RN license

  • Education: Bachelor's Degree

  • Ability to be licensed in multiple states without restrictions

  • Prior clinical experience and expertise preferably in an acute care or provider setting practice

  • Knowledge and experience working with nationally established clinical quality guidelines and measurement sets such as HEDIS/NCQA or Joint Commission Standards for Accreditation

  • Understanding of clinical programs

  • Ability to work with a team

  • Strong analytical skills, able to research, manipulate and interpret data

  • Ability to measure, monitor, and track improvements in clinical care utilization

  • Ability to demonstrate problem solving skills

  • Organizational and prioritization skills

  • Valid driver’s license and dependable transportation necessary

  • Excellent public speaking skills

Role Desirables

  • Health Plan experience

  • Previous Medicare/Medicaid Experience a plus

  • Utilization management knowledge and experience

  • Provider and member rewards program knowledge and experience

  • Experience in a state and/or federally regulated health care environment

  • Understanding of medical coding

Reporting Relationships

  • You will report to a Quality Manager. This area is under the leadership of the SVP & Chief Operations Officer.

Additional Information

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 RN - Richmond, VA

Location: Virginia-Glen Allen

Requisition ID: 178838