Job: RN Clinical Advisor - Miramar, FL
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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: RN Clinical Advisor
Assignment: QUALITY COMPLIANCE AND ACCREDITATION
Location: Miramar, FL
Are you a fit?
As a registered nurse, do you enjoy working in a dynamic Quality Improvement environment? Identifying opportunities to improve member care and service? Identifying opportunities to partner with and educate providers? All toward the same goal! Improving the health of our health plan members
- Medicare, Commercial, Medicaid and Special Needs Plans. If so then read on!
The RN Clinical Advisor will demonstrate compliance to accreditation, state and Federal regulations.
Other responsibilities include:
Collect various type of data, HEDIS, medical record documentation, peer review information.
Investigate potential quality issues. Work with provider partners to improve processes.
Identify opportunities for improvement, conduct barrier analysis and develop and implement initiatives.
Participate and collaborate in various work groups to demonstrate your strengths, skills and expertise. Lead projects as necessary.
Leveraging Technology: You are 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.
Active Registered Nurse (RN) nursing license in the state of Florida.
Minimal 2+ years of prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
Ability to work independently under general instructions and within a team setting.
Flexible in work assignments and able to work with deadlines.
Resident of Broward or Dade County.
Valid driver's license in the state of Florida and dependable transportation.
Education: Bachelor's degree in Nursing (BSN) or nursing diploma.
Prior Health Plan experience.
Previous Medicare/Medicaid Experience.
Previous experience in quality management and improvement.
Previous HEDIS data collection.
You will report to a Director or Quality Manager.
Skills / Requirements