Clinical Advisor RN - Quality Review - Louisville – Louisville

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies, with approximately 11 million medical members located primarily in 15 states and Puerto Rico. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Over its 43-year history, Humana has consistently seized opportunities to meet changing customer needs.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.


Role: Clinical Advisor RN - Quality Review
Assignment: Quality Management
Location: Louisville, KY

Are you a fit?
The Humana Quality Management department is looking for a self-motivated detail-oriented RN who functions well as a team player. This person will work closely with Humana providers to develop collaborative relationships and will be based in the Humana Lexington office.
Assignment Capsule

• You will contribute to the successful implementation of the Quality Nurse Program in your assigned area.
  
• You will promote physician relationships, improve quality, communication, and complete provider orientations.
  
• You will contribute to the goal of achieving Excellent Accreditation status for NCQA surveys and in completion of all Quality Improvement activities/goals, improving HEDIS/CAHPS rates
  
• You will contribute to the success and positive work environment
  capable of producing innovative quality initiatives to improve the
  overall health of the membership

• Leveraging Technology: You have technological savvy and know how to appropriately share and use your knowledge to improve business results.
  Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
  
• Is Accountable: You meet clearly stated expectations and take responsibility for achieving results.
  
• Clinical Knowledge: You understand clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications of such programs
  
• Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.

• Self-motivated and directed
  
• Ability to display Skills in Communication both verbal and written
  
• Maintains mutual respect and ensures mutual understanding with staff and vendors.
  
• Exercises active listening skills as demonstrated by: Inquires about, identifies and understands the needs and perspectives of others. Understands the audience and tailors delivery accordingly; shares information appropriately. Presents information and/or
  recommendations verbally, graphically and/or in writing.
  
• Chooses and adeptly uses appropriate technology tools, methodology and solutions. Champions the wide use of technology applications. Knowledgeable in Microsoft Office products.
  
• Effectively leverages available resources (financial, people, time) to accomplish objectives and maximize return on investment.
  
• Makes appropriate decisions in the face of ambiguity. Anticipates and resolves barriers and constraints.
  
• Organizes and manages multiple priorities and/or projects using appropriate methodology and tools.
  
• Proactively identifies and evaluates problems. Identifies appropriate subject matter experts and other information resources to resolve problems.
  
• Collects, analyzes and draws conclusions from information. Leverages appropriate problem-solving/analysis tools and/or steps.

• Ability to manage several projects simultaneously and effectively
  
• Strong presentation and communication skills both verbal and written
  
• Ability to work collaboratively and independently
  
• Demonstrate high level of experience with Microsoft Word, Excel, PowerPoint, and the Internet.
  
• Initiate quality reviews and facilitates the QI process
  
• Attend and participate in the
  
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