Quality Compliance Nurse Professional 2 - Louisville KY

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Job Information

Humana

Quality Compliance Nurse Professional 2 - Louisville, KY

in

Louisville

Kentucky

Description

The Quality Compliance Nurse Professional 2 uses quality improvement methodology to analyze data and works collaboratively with teams to improve quality for KY Medicaid members.

Responsibilities

The Quality Compliance Nurse Professional 2 leads quality improvement projects and monitor performance metrics for KY Medicaid, leads a provider medical record documentation review audit, and participates in multidisciplinary committees, both external and internal. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures

The Quality Compliance Nurse Professional 2 is responsible for managing Kentucky market quality improvement activities. This includes:

Using quality improvement methodology to analyze data and working collaboratively with teams to improve quality for KY Medicaid members

Developing quality improvement plans for both performance and focus HEDIS measures, and other measures as defined by various monitoring activities (i.e. CAHPS)

Monitoring and reporting progress towards goals for performance and focus measures.

Completing reports (including State Reports and Kentucky Medicaid Quality Improvement Committee reports).

Chairing interdisciplinary quality improvement workgroups

Leading annual medical record documentation review audits

Participating in multidisciplinary committees, both internal and external

Supporting annual quality document updates (example: quality improvement program description and evaluation)

Other activities as assigned

Will report to the Louisville, KY Office once a quarter for meetings

Required Qualifications

Unrestricted Registered Nurse with active Kentucky License

At least 2 years previous experience in Quality Improvement OR Quality Operations OR Clinical Operations

Understanding of healthcare quality measures (example HEDIS, CAHPS)

Comprehensive knowledge of Microsoft Office Word, PowerPoint, intermediate Excel experience (pivot tables/filtering, charts, formulas)

Must reside in KY, IN, OH within driving distance of Louisville, KY to attend meetings (see additional information below)

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination or commit to testing protocols

*OR  *

Provide proof of applicable exemption including any required supporting documentation

​​Medical, religious, state and remote-only work exemptions are available.

Work At Home Requirements

Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.

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

Certified Professional in Healthcare Quality (CPHQ)

Quality improvement experience with the Medicaid population

Additional Information

Onsite Travel

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

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. Modern Hire 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 Modern Hire 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.

Scheduled Weekly Hours

40

Company info

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