Humana Quality Management Coordinator in Pittsburgh, Pennsylvania

Role: Quality Management Coordinator - RN
Assignment: Humana Government Business Location: Work at Home, location is flexible

Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule Executes the Humana Military Clinical Quality Management Program (CQMP) and other administrative quality initiatives. This includes analysis of Potential Quality Issues (PQI) analysis, medical record request and review, and maintenance of QM-related records. Consults with the Medical Director on cases. Researches quality issues; documents findings and actions, and tracks and trends events in QM information systems; prepares and presents cases for peer review as assigned; and documents, implements, and monitors corrective action plans to completion. Supports process/performance improvement initiatives.

  • Our Department of Defense Contract requires U.S. citizenship for this position *

    Role Essentials

    • Minimum three years clinical nursing experience

    • Our Department of Defense contract requires U.S. Citizenship

    • Active licensed RN in state of employment

    • Minimum two years of UR or QM

    • Working knowledge of a PC office suite (including word processing) and data base knowledge

    • Excellent written and verbal skills

    • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing) Role Desirables

    • Bachelor's Degree

    • Accreditation (URAC, NCQA or JCAHO) experience

    • Working knowledge of Microsoft Office Professional including knowledge in data management, data reporting and statistical analysis Additional Information Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Title: Quality Management Coordinator

Location: Texas-San Antonio

Other Locations: US-OH-Cincinnati, US-Pennsylvania-Pittsburgh, US-KY-Louisville, US-South Carolina-Lancaster, US-FL-Tampa, US-Louisiana-New Orleans, US-GA-Atlanta

Requisition ID: 171864