Quality Improvement Nurse-Morgantown, WV Job in Morgantown, West Virginia US

Role: Quality Improvement Nurse
Assignment: Senior Products
Location: Morgantown, WV

Assignment Capsule
The Quality Improvement Nurse will facilitate and work collaboratively with provider groups focused on Medicare Senior Products, Commercial and Medicaid plans to guide, recommend and develop practice specific strategies designed to improve all aspects of quality.

 

Are you a fit? Do you have a desire to be in a position to enhance quality and help identify opportunities for improvement and make recommendations.

·         Effectively develop, enhance and maintain provider clinical relationship across product lines

·         Deliver provider/member-specific metrics (e.g., SQR reports, Member on a page, Anvita alerts) and coach providers on gap closing opportunities for Humana members

·         Successfully promote practice-patients’ participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement

·         Accurately define gaps in Humana’s service relationship with providers and facilitate resolution

·         Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support

·         Review medical records and identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture, use SQR to identify information and provide guidance to practice)

·         Effectively coach provider office staff on best means to communicate with Senior members that may have hearing, vision, physical abilities challenges (i.e. Perfect Service orientation)

Reporting Relationships

•                      This role reports to the Front Line Leader

Additional Information

•                      This role will work closely with Market/Region MRA, HSO and Provider Relations Staff.

Role Essentials

·         Experienced clinical background as RN

·         Strong analytic skills and ability to use data to drive improvement activities

·         Previous quality or process improvement experience in a hospital or physician office practice

·         Previous experience and/or knowledge of Quality Improvement or process improvement

·         Strong organizational and prioritization skills with ability to collaborate with multiple departments

·         Detail orientated and comfortable working with tight deadlines in a fast paced environment

·         Ability to work independently under general instructions, self-directed and motivated

·         Excellent PC skills (including MS Word, Excel and PowerPoint)

·         Willing to travel.

 

Role Desirables

·         Knowledge of Provider Rewards and MRA Coding

·         Previous clinical or health plan operations experience

·         BSN or Bachelor’s degree in a related field.

·         Prior Medicare or Medicaid experience.

·         Knowledge of HEDIS/Stars/CMS/Quality