Senior Quality Compliance Nurse RN - Louisville KY or Remote KY

Profile

Description

The Senior Quality Compliance Nurse (RN) utilizes quality improvement methodology and works collaboratively with departmental and interdisciplinary teams to monitor quality, outcomes, and compliance processes. This role works with physicians/physician groups, internal contacts, as well as community outreach contacts to ensure highest accountability of compliance and quality. The Senior Quality Compliance Nurse understands organization strategy, understands linkages to related areas and makes decisions regarding work methods to complete assignments, interprets outcomes and makes independent determination of the appropriate courses of action.

How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Responsibilities

The Senior Quality Compliance Nurse (RN) manages the Quality Improvement and Performance Improvement Program by using quality improvement methodology to analyze data and working collaboratively with teams to improve quality for KY Medicaid members. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Work is guided by contractual, accreditation, and CMS requirements. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.


Updates, manages, and complies the QI requirement documentation (QI Program Description, QI Work Plans, and QI Evaluation)
Updates and manages a repository of Policy/Procedures
Develops, implements, and evaluates activities of state required Performance Improvement Projects (PIPs) in collaboration with internal and external partners
Coordinates External Quality Review Organization (EQRO) activities
Facilitates/participates in quality committees and quality improvement related meetings and discussion with internal and external partners
Uses quality improvement methodology to analyze data and works collaboratively with teams to improve quality for KY Medicaid members
Evaluates project/program activities and results to identify opportunities for improvement.
Other task, duties, projects and programs as assigned


Required Qualifications


Registered Nurse (RN) with active Kentucky License with no restrictions
3 years of experience working on healthcare quality and performance measure improvement activities (example HEDIS, CAHPS)
2 years of clinical and/or quality experience in Health Plan
2 years of project management experience (example PIP, QIP, CCIP, and/or QS) required by CMS/State Agencies
Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel, and Visio
Ability to work independently under general instructions, must be self-directed and motivated
Must be passionate about contributing to an organization focused on continuously improving quality for our members


Preferred Qualifications


Certified Professional in Healthcare Quality (CPHQ)
Quality Improvement experience with the Medicaid population
Knowledge of NCQA accreditation, CMS, and state requirements


Additional Information

This position will need to be located either in Louisville, KY or Remote KY as this position will need to come into the office on a quarterly basis.

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

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 (satellite and/or wireless internet connections are NOT permitted for Work at Home roles) 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

Scheduled Weekly Hours

40

Company info

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