What Does A Home Improvement Contractor Do At Humana
* Critical thinking to prioritize PCP outreach based on what will deliver greatest return on investment (i.e. who to outreach, frequency of outreach, visit focus, communication method / collateral) * Evaluate provider current state willingness to work with Humana to improve Stars performance and tailor messaging accordingly * Identify key point of contact for each prioritized PCP and effectively develop / enhance provider clinical relationship across product lines.* Accurately define gaps in Humana’s service relationship with providers and facilitate resolution through Service Alignment Manager (SAM) * Deliver provider/member-specific metrics and supporting collateral (e.g., HEDIS Summary, Patient Experience, Rx Opportunity, etc.) and coach providers on improving all aspects of Stars performance * Educate PCP’s on Stars program, changes and best practices to enhance all aspects of Stars performance * Identify provider best practices and needs, disseminate for sharing and / or resolution * Maintain documentation of provider visit, including focus and performance trending (Quality Journal) * Facilitate effective collaboration and communication with workgroup members (including operations, clinical and MRA) and Stars and Quality team members * Identify opportunities to improve Stars and Quality processes, methods, team engagement, etc. and present resolution options / cost * Role Essentials * Experienced clinical background as RN or LPN * At least 3 years of varied clinical nursing experience * History of taking on roles of increased responsibilities with proven results * Self-directed and motivated, with proven ability to work independently given general instructions * Strong communication and public speaking skills; proven influencer * Strong organizational and prioritization skills with ability to collaborate across multiple departments * Detail orientated, forward looking and comfortable working with tight deadlines in a fast paced, dynamic environment * Demonstrated proficiency with MS Office Suite (Word, Excel and PowerPoint) * This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program.* If selected for this role, you will be required to be screened for TB. * Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10Mx1M * Role Desirables * Knowledge of CMS Stars Program elements, including HEDIS, Patient Experience and Patient Safety * Strong Communication and Collaborative/Teamwork Skills and abilities * Physician office practice experience * Previous experience and/or knowledge of Quality Improvement or process improvement * Strong analytic skills and ability to use data to drive improvement activities * Previous Health Insurance clinical or operations experience * Reporting Relationships * This role reports to the Frontline Leader, Manager and Quality Improvement Director. * Additional Information * Work at Home role traveling 75% of the time * This role works closely with Market Operations, MRA, HSO and Clinical teams * Interview Format * As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability.* Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. * If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview.* In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question.* You should anticipate this interview to take about 15 to 30 minutes.* Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews
