Quality Compliance Nurse Professional

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, supports medical record audit, and implement member and provider targeted interventions. 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, but not limited to:

• Monitoring and reporting progress towards goals for performance and focus measures.
• Supporting quality document updates (example: quality improvement program description, work plan, and evaluation)
• Implement member and provider targeted interventions.
• Other activities as assigned
• Supporting quality statuary reporting, committee meetings, work groups.
• Conducting medical record audits
• Developing quality improvement plans for both performance and focus HEDIS measures, and other measures as defined by various monitoring activities (i.e. CAHPS)
• Using quality improvement methodology such as PDSA to analyze data and working collaboratively with teams to improve quality for KY Medicaid members

Required Qualifications

• At least 3 years previous experience in quality improvement/quality operations
• Unrestricted Registered Nurse with active Kentucky License
• Comprehensive knowledge of Microsoft Office Word, PowerPoint, intermediate Excel experience (pivot tables/filtering, charts, formulas)
• Knowledge of HEDIS/CAHPS/Stars/CMS/Quality
• At least 5 years of RN experience in clinical setting OR Health Plan

Preferred Qualifications

• Ability to work independently under general instructions, self-directed and motivated.
• Project management experience
• Quality improvement experience with the Medicaid population
• Previous quality or process improvement experience in a hospital or physician office practice
• Detail orientated and comfortable working with tight deadlines in a fast-paced environment..
• Certified Professional in Healthcare Quality (CPHQ)

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Associates 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.
• Satellite, cellular and microwave connection can be used only if approved by leadership
• 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
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Additional Information

COVID 19 vaccine

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

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Scheduled Weekly Hours

40