Quality Improvement Nurse - RN
Location: Albuquerque New Mexico
Description: Humana is at present looking to employ Quality Improvement Nurse - RN right now, this vacancy will be placed in New Mexico. More complete informations about this vacancy opportunity kindly read the description below. Be a part of our Clinical Space â€" as a Clinical Advisor you will engage our members to develop lifelong wellbeing and health.
Humana is seeking a Clinical RN! Advisor who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria.
Manage network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design
Recommend services for Humana Plan members utilizing care alternatives available within the community and nationally
Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols
Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria
Conduct admission review, post-discharge calls and discharge planning
Key Competencies
Builds Trust
: Consistently m! odels and inspires high levels of integrity, lives up to commi! tments, and takes responsibility for the impact of one's actions.
Accountability
: Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Customer Focus
: Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.
Executes for Results:
Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
Qualifications
Role Essentials
Active RN license in New Mexico
Ability to be licensed in multiple states without restrictions
Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Ability to work independently under general instructions and with a team
Valid drivers l! icense and/or dependable transportation necessary (variable by region)
TB test required (if hired)
75% travel required in the state of New Mexico
Role Desirables
Education: Associate or Bachelor's degree in Nursing
Health Plan experience
HEDIS experience
STARS
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Previous experience in utilization management, discharge planning and/or home health or rehab
Bilingual is a plus
Additional Information
Humana is an organization with careers that change livesâ€"including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing ! and poised to make an impact on the future of healthcare, Humana has th! e right opportunity for you.
Apply now, or join our Talent Network so you can stay informed and up to date on what’s happening at Humana.
Schedule
:
Full-time
Primary Location
:
US-New Mexico-Albuquerque
Role
:
Clinical Innovations and Health Practitioners
Work Environment Type
:
Office
Travel
:
Yes, 25 % of the Time
- .
If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Humana.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Wed, 14 Aug 2013 20:29:48 GMT