Humana Quality Improvement Nurse Consultant (RN) - Tucson, AZ (Pima County) in Tucson, Arizona

Role: Quality Improvement Nurse Consultant, RN
Assignment: Medicare Location: Tucson, AZ (Pima County)

Assignment Capsule
Looking for the right candidate who has a strong sense of community and knowledge of the Tucson 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.

    Role Essentials

  • 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.

  • Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10 panel drug test Role Desirables

  • 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.

    The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective April 1, 2011, Humana has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.

    Interview Format

    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) - Tucson, AZ (Pima County)

Location: AZ-Tucson

Requisition ID: 177248

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.