Role: HEDIS Nurse - VSP Assignment: Quality Operations, Compliance and Accreditation Location: Work at home
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.
Be a part of our Clinical Space – as a Clinical Advisor in Quality Operations you will be working to improve the members’ lifelong wellbeing and health.
Humana is seeking a Quality Operations, Compliance and Accreditation nurse. You will collaborate with other Humana departments and our network providers as it relates to Quality activities associated with HEDIS, CAHPS, CMS, NCQA and any other compliance requirements for the Health Plan.
As a Quality Nurse you will be responsible for:
Contacting providers for records needed for reviews via phone, mail or fax
Compliance to state, CMS, and federal regulations
Pass HEDIS IRR and HEDIS Measure Test after training is completed
Review and Research HEDIS records with accuracy and timely
Pass HEDIS MRRV with no major issues found
Work flexible hours throughout the HEDIS season as needed
Interact with Commercial and Medicare Market leaders, other departments, and the community to promote Humana programs and strategic initiatives.
This role is a VSP: Variable Staffing Pool are Associates who work flexible hours to meet business needs, with no guaranteed minimum or maximum number of hours in any week.
Active unrestricted professional license
Ability to be licensed in multiple states without restrictions.
Minimum of 3 years prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
Ability to work independently under general instructions and with a team.
Valid driver's license and/or dependable transportation necessary.
Excellent computer skills and knowledge of Microsoft Word, Excel and PowerPoint.
RN or LPN license
Education: BSN or Bachelor’s degree in a related field
Knowledge of HEDIS specifications and data collection
Previous Medicare/Commercial Health Plan experience
Previous experience in quality or utilization management
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.
Title: HEDIS Nurse - Quality Operations - VSP
Other Locations: US-WI-Green Bay, US-AZ-Phoenix, US-Texas-San Antonio, US-Missouri-Springfield, US-OH-Cincinnati, US-FL-Tampa
Requisition ID: 181797
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.