Senior Quality Compliance Nurse Professional

Humana

10d • Hybrid

About The Position

The Senior Quality Compliance Nurse Professional is an integral part of the Oklahoma Quality Improvement Department. This role will collaborate with internal and external customers to meet benchmarks, goals and complete time sensitive deliverables for Quality Improvement clinical and non-clinical performance projects. The role operates as a subject matter expert in Quality Compliance. The Senior Quality Compliance Nurse Professional makes decisions on moderately complex to complex issues regarding technical approach for project components, works independently, sometimes in ambiguous situations and work may be performed with minimal direction to ensure the highest accountability of compliance and quality. This position will be involved in studies as required by the External Quality Review Organization or the State and monitors activities and performance metrics for the Oklahoma Medicaid program. The Senior Quality Compliance Nurse Professional exercises considerable latitude in determining objectives and approaches to assignments, with work that influences the quality department and the Oklahoma Medicaid strategy. This role will completes data analysis and implement quality improvement programs as needed. Decisions would be related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Success in this role will require departmental and managed care collaboration, . May participate in multidisciplinary committees, both external and internal and conduct briefings and area meetings. Use your skills to make an impact

Requirements

• RN License for State of OK required, unrestricted
• Bachelor's degree or 4+ years relevant work experience in healthcare settings
• Knowledge of quality and process improvement approaches (PDSA, DMAIC, etc.)
• Experience presenting information to internal and/or external stakeholders
• Demonstrated ability to partner with senior leadership on strategic initiatives
• Comprehensive knowledge of Microsoft Word, Excel and PowerPoint.
• Must reside in the state of Oklahoma.
• 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.
• Employees 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Experience with Medicaid programs strongly preferred.
• Previous experience with QI Science and methodologies (IHI).
• Certified Professional in Healthcare Quality (CPHQ)
• Project Management skills
• Proficiency in verbal and written communication to senior and executive leadership
• Strong organizational skills and ability to manage multiple or competing priorities.

Responsibilities

• Collaborate with internal and external customers to meet benchmarks, goals and complete time sensitive deliverables for Quality Improvement clinical and non-clinical performance projects.
• Operate as a subject matter expert in Quality Compliance.
• Make decisions on moderately complex to complex issues regarding technical approach for project components
• Work independently, sometimes in ambiguous situations and work may be performed with minimal direction to ensure the highest accountability of compliance and quality.
• Involved in studies as required by the External Quality Review Organization or the State and monitors activities and performance metrics for the Oklahoma Medicaid program.
• Exercise considerable latitude in determining objectives and approaches to assignments, with work that influences the quality department and the Oklahoma Medicaid strategy.
• Completes data analysis and implement quality improvement programs as needed.
• Participate in multidisciplinary committees, both external and internal and conduct briefings and area meetings.

Benefits

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 5,001-10,000 employees