Join Our Team: Enhancing Healthcare Quality and Wellness
Humana, a leading healthcare company, is seeking a dedicated and experienced Registered Nurse (RN) Quality Improvement Professional to join our team. As a Quality Improvement Professional, you will play a crucial role in implementing and driving our Health Plan's Quality Improvement (QI) Program, ensuring compliance with accreditation, state, and federal regulations, and enhancing the overall quality of care for our members. This is a unique opportunity to work remotely and make a meaningful impact on the healthcare industry.
About Humana and CarePlus Health Plans
Humana Inc. (NYSE: HUM) is a committed leader in healthcare, dedicated to putting health first for our teammates, customers, and company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health. CarePlus Health Plans, a wholly owned subsidiary of Humana, is a recognized leader in healthcare delivery, offering Medicare Advantage health plans in Florida for over 23 years. We strive to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about.
Job Summary
We are looking for a highly skilled and experienced RN Quality Improvement Professional to join our team. As a Quality Improvement Professional 2, you will be responsible for implementing and driving our Health Plan's QI Program, ensuring compliance with accreditation, state, and federal regulations, and enhancing the overall quality of care for our members. This is a remote opportunity with a competitive salary and comprehensive benefits package.
Key Responsibilities
- Participate in required audits to meet accreditation and regulatory requirements, and assist with corrective action plans.
- Assist with survey preparation, committee preparation, presentation, and documentation.
- Collect, research, and review data during annual HEDIS Chart Review season, and participate in strategy, training, planning, and implementation meetings.
- Review and investigate potential quality issues, and implement appropriate and timely actions.
- Assist with and/or attend Peer Review Committee (PRC) activities, and assist with documents to be presented to PRC.
- Review medical records for medical record keeping practices and recommend quality improvements.
- Participate in work groups, lean projects, and task forces, which may include analysis and improvement activities, community outreach, and partnerships.
Requirements
Essential Qualifications:
- Bachelor's degree in a related field.
- Reside in FL, GA, NC, or SC.
- 3 or more years of clinical and/or health plan experience.
- RN active unrestricted compact license or FL license.
- Experience in a fast-paced insurance or healthcare setting.
- Experience in provider relations.
- Understanding of healthcare quality measures, such as STARS and HEDIS.
- Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.
- Proven analytical skills.
Preferred Qualifications:
- Knowledge of Humana's internal policies, procedures, and systems.
- Experience in quality management.
- Certified Professional in Healthcare Quality (CPHQ).
Skills and Competencies
To succeed in this role, you should possess:
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills.
- Ability to work in a fast-paced environment and prioritize multiple tasks.
- Strong attention to detail and organizational skills.
- Ability to work independently and as part of a team.
Career Growth Opportunities and Learning Benefits
At Humana, we are committed to the growth and development of our associates. We offer:
- Competitive salary and benefits package.
- Opportunities for professional growth and development.
- Comprehensive training programs.
- Flexible work arrangements, including remote work options.
Work Environment and Company Culture
Our company culture is built on a foundation of respect, integrity, and compassion. We strive to create a work environment that is:
- Inclusive and diverse.
- Supportive and collaborative.
- Flexible and adaptable.
- Focused on employee well-being.
Compensation, Perks, and Benefits
We offer a comprehensive compensation package, including:
- Competitive salary: $63,400 - $87,400 per year.
- Bonus incentive plan.
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave).
- Short-term and long-term disability.
- Life insurance.
Travel Requirements
5% travel required.
Interview Process
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Equal Opportunity Employer
Humana is an equal opportunity employer committed to diversity and inclusion. We welcome applications from qualified candidates of all backgrounds.
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If this role sounds like a perfect fit, don't hesitate. Apply today and let's build the future together.
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