Clinical Advisor RN - Quality Review – Chicago

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. 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.

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: Chicago, IL

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 Louisville 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 quality improvement committee meetings
  
• Visit provider offices to promote education and quality improvement activities
  
• Coordinate and manage clinical studies, performs audits, develop clinical interve
  
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