Humana Quality Improvement Nurse-Pensacola, FL and Mobile, AL in Mobile, Alabama

Role: Quality Improvement Nurse – RN
Assignment: Transcend - a wholly owned subsidiary of Humana
Location: Pensacola, Florida or Mobile, Alabama

*This is a Work-At-Home opportunity for candidates located in the Pensacola, Florida or Mobile Alabama and immediate surrounding areas only *

We help doctors do what they do best while engaging patients in their care
At Transcend we recognize the need to simplify population health management for the people who provide health care. We support physicians and care teams, provider groups and integrated delivery systems with practical onsite services and solutions that help practices shift from a health care system built on treatment transactions to a value-based model built on better outcomes for patients more engaged as partners in their own care.

Role Description
At Transcend Population Health Management LLC, we deliver population health care and financial risk management, clinical-integration technology, and physician engagement services to health care providers through a captive Independent Physician Association model. Transcend leaders and market teams work onsite at physician practices to provide operational and medical management infrastructure support, patient outreach and medical records management. We also offer customized, intuitive technology that makes the administrative side of value-based care easier for physicians and their teams.

As a Quality RN, you will work collaboratively with providers to focus on chronic/complex care members as related to HEDIS and Risk Adjustment measures to come up with solutions to improve member outcomes. The Quality RN will focus 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:
* Develop, facilitate, and/or secure opportunities to positively impact Triple Aim (cost/quality/documentation)

  • Ensure quality goals are aligned and executed effectively

  • Provide resources, educates and coaches provider practices on Quality Improvement

  • Assess and leverage provider technology to promote prospective and retrospective medical record abstraction

  • Oversees HEDIS reporting and trend to identify opportunities for quality improvement

  • Partners with cross-functional teams, including, Sr. Product/health plan Quality Management to encourage member participation in population health

  • Drives STAR measures: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Outcome Surveys (HOS), Care Management Services (CMS) and Healthcare Effectiveness Data Information Sets (HEDIS)

    Role Essentials

  • Active RN license in either or both state(s) Florida and Alabama in which the nurse is required to practice

  • Ability to be licensed in multiple states without restrictions-license in both FL and AL required, only one at time of hire is needed.

  • Clinical experience in a healthcare setting combined with quality improvement and administrative background

  • 2-5 years Experience working with Core Measures, HEDIS, HOS and/or CAHPS surveys, JCAHO, NCQA, CMS or other regulatory guidelines

  • Strong communication skills; ability to develop and foster relationships

  • Ability to work independently under general instructions and with a team

  • Valid driver’s license

  • Ability to travel to local provider offices 3-4 days a week in the Pensacola Florida, Mobile Alabama and surrounding areas

  • High level of proficiency with MS Products, specifically Outlook and Excel as well as experience with EMRs and aptitude to learn clinical systems

  • 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

  • If selected for this role, you will be required to complete and pass background check/investigation for AHCA compliance

    Role Desirables
    · BSN or Bachelor’s degree in a health Care and or business related field
    · Health Plan or provider practice experience · Previous Medicare andexperience · Previous experience in quality management; population health management is a plus

    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 for you pertaining to your relevant skills and experience at a time that is best for your schedule.

Title: Quality Improvement Nurse-Pensacola, FL and Mobile, AL

Location: AL-Mobile

Other Locations: US-AL-Mobile

Requisition ID: 178541