Quality Improvement RN - Peoria AZ

Humana • Peoria, IL

94d • $71,100 - $97,800

About The Position

The Quality RN Professional is responsible for the development, implementation, and management oversight of the company's Medicare/Medicaid Stars Program. The role involves varied work assignments that frequently require interpretation and independent determination of appropriate courses of action. The Quality RN Professional collaborates with market leadership and the quality improvement team to develop and implement programs designed to improve patient outcomes. Work is performed within the associate's primary center location and in collaboration with existing Quality Improvement Coordinators and Professionals, in close partnership with market and center teams. Patient interaction is required for this role, completed both telephonically and through in-person visits for activities such as patient education, point-of-care testing, and screenings as needed (including Retinavue eye exams, HgA1c draws, etc). The Quality RN Professional represents the scope of provider relationships across various areas including Quality/clinical management and population health, HEDIS and Stars performance, operational improvements, data sharing and connectivity, documentation and coding, and additional areas related to provider performance, member experience, market growth, provider experience, and operational excellence.

Requirements

• Licensed Registered Nurse (RN) without restriction in applicable state.
• 5+ years of clinical nursing experience.

Nice To Haves

• Strong knowledge of HEDIS/Stars/CMS.
• Bachelor's Degree in Nursing.
• 3+ years of managed care experience.
• 3+ years of case management experience.
• Bilingual; English and Spanish preferred.
• Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement.
• Excellent presentation and communication skills, both oral and written.
• Strong relationship building skills.
• Strong attention to detail with a focus on process and quality.
• Comprehensive knowledge of Microsoft Office applications.

Responsibilities

• Develop, implement, and manage the Medicare/Medicaid Stars Program.
• Collaborate with market leadership and quality improvement teams.
• Conduct patient education and screenings both telephonically and in-person.
• Represent provider relationships in quality management and population health.
• Oversee HEDIS and Stars performance.
• Facilitate operational improvements and data sharing.
• Ensure proper documentation and coding.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays.
• Volunteer time off.
• Paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree