Quality Improvement RN - Peoria AZ

Quality RN Professional

The Quality RN Professional is responsible for the development, implementation, and management oversight of the company's Medicare/Medicaid Stars Program. The Quality RN Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Quality RN Professional collaborates with market leadership and 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 and in close partnership with market and center teams. Patient interaction is required for this role and is 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 the following areas:

• Quality/clinical management and population health
• HEDIS and Stars performance
• Operational improvements
• Data sharing and connectivity
• Documentation and coding
• Additional areas related to provider performance, member experience, market growth, provider experience, and operational excellence

Required Qualifications

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

Preferred Qualification

• 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, not required, unless otherwise specified
• 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 as this is a provider-facing role
• Strong attention to detail with a focus on process and quality
• Comprehensive knowledge of Microsoft Office applications

Additional Information

• Hours for the role: Monday-Friday 8am-5pm local time zone
• This role is based within the provider office with occasional rotation through other centers within the assigned territory.

TB Statement

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Driving Statement

This role is part of CenterWell's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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, and many other opportunities.