RN Quality Improvment Professional - Virtual/work from home

Humana - Miramar, FL3.7


The Quality Improvement Professional 2 implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Quality Improvement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The hours of this role are Mon-Fri, 8am-5pm est.

The Quality Improvement Professional 2 monitors quality investigations and compliance processes. Manages quality management system, department SharePoint, and department reporting. Audits processes as needed for compliance. Completes and submits reports to CMS and state regulators as required for clinical studies. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

P a r ti c i p a t e s i n re q u i r e d aud i t s t o m eet a l l a c c re d it a t i on a n d re g u l a t ory r e qu i re m en t s. Participation with c o r r ec t i v e ac t i on p l a n s. A s s i s t w i t h s u r v ey prepar a t i on and p a r t i c i pa t e w it h sur v ey pro c ess as neede d . A ss i st w it h c o m m itt ee p r ep a ra t i on, pr e s e n t a ti on and d ocu m en t a ti on. Assist with annual Quality documents as assigned.
C o ll e c t i on, research and r e v i ew of a nnu a l HED I S project . Active participation in strategy, planning and implementation meetings. A ct as HED I S C oord i n a t or and / o r a u d i t o r s, as assigned .
R e v i e w / in v e s ti g a t i on o f p o t e n t i a l qu a l i t y i ss u es fo l l o w i ng pre s c r i bed g u i d e l i nes and i m p l e m en t a t i on o f a p pro p r i a t e / ti m e l y ac t i o n s. Assists and/or attends with Peer Review Committee activities as needed.
R e v i ew m ed i cal r ec o rds for m ed i ca l r e co r d k eep i ng pra c t i ces if applicable. C o ndu c t coor d i n a t i on and co n ti n u it y of care s t u d i e s and recommend quality improvements as needed.
Par ti c i p a t i on i n w o rk g roups/lean projects/ t ask f o rc e s m a y i nc l u d e but a r e n o t li m it ed t o a n a l y s i s and i m pro v e m ent a c ti v i t i es, co mm un it y ou t r e ach a nd p a r t ne r sh i p s.

Required Qualifications

Active RN license without restrictions
Ability to be licensed in multiple states without restrictions
Prior clinical experience in an acute care, skilled or rehabilitation clinical setting
Experience with quality improvement processes pertaining to Medicare guidelines
Excellent computer skills and ability to easily navigate multiple applications
Ability to work independently under general instructions and with a team
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
Preferred Qualifications

BSN or advanced degree
Managed care experience
Additional Information

As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.

If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.

Scheduled Weekly Hours