Quality Improvement Nurse Work at Home KS AR OK MO NE IA

Profile

Description

The Senior Stars Improvement, Clinical Professional responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Senior Stars Improvement, Clinical Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Stars Improvement, Clinical Professional This work focuses on areas of clinical emphasis. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Subject matter expert on Stars measures, i.e., HEDIS, Patient Safety, CAHPS, HOS

Able to articulate relevant healthcare quality standards and provide educational support related to Stars measures.

Perform data analysis related to Stars level from a variety of perspectives, e.g., provider, group, contract, state or region, to conduct performance improvement activities using PDCA (Plan, Do, Check, Act) cycle

Coordinate member outreach related to Stars measures to promote a holistic approach to wellness

Coordinate outreach with other departments, i.e., Corporate Initiatives, Market Point team, Health Services

Develop tracking methodology to avoid duplication of effort

Provide appropriate referrals to Humana Clinical programs to for disease management or coordination of care

Conduct telephonic outreach to Humana members to address gaps in care. Apply nursing knowledge to promote optimal health outcomes.

Identify and coordinate data capture for specific patient care gaps

Work in concert with MRA team members, e.g., Schedulers and Retrieval Specialists, to obtain medical records

Promote collaboration with Provider Engagement department to identify and target providers with low quality scores

Determine causation of low scores, i.e., documentation, member compliance, education needs

Perform chart reviews, on-site or remotely, retrospective or concurrently

Required Qualifications

Active RN license in the state(s) in which the nurse is required to practice

Ability to be licensed in multiple states without restrictions

2-4 years clinical experience in ambulatory care setting

2-4 years of experience in retrospective chart review and interpretation of clinical quality standards

Comprehensive knowledge of all Microsoft Office applications, including Word and PowerPoint with a strong emphasis on the use of Excel

Comfortable in presenting information to large groups, able to prepare PowerPoint presentations with attention to accuracy of information

Ability to work independently under general instructions and with a team

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Ability to travel up to 10% locally

Valid driver's license and/or dependable transportation necessary

Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required

Preferred Qualifications

BSN or Bachelor's degree in a related field

2-4 years of Health Plan experience

2-4 years Medicare/Medicaid experience a plus

Call center or triage experience

2-4 years' experience in utilization management, discharge planning and/or healthcare quality

Proficient in at least one EMR system and familiar with chart review process

Flexible - daily learnings, role modification in response to organizational needs. Matrix organization, skilled and enthusiastic collaborator

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com