Quality Review Nurse, RN – Phoenix

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 Innovations / Clinical Advisor, RN
Assignment: Quality Review Nurse
Phoenix Arizona : Phoenix, AZ

Aissignment Capsule
1. Monitoring and investigation of member complaints
2. Performing medical record reviews
3. Analysis of data
4. Participation in Regulatory & Accreditation Activities
5. Collaboration with other Health Care Departments
6. Utilizing clinical knowledge to identify members for Clinical Programs
7. Physician visits/education

Key Competencies

• 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.

Role Essentials
1. Current Arizona RN License
2. Valid Arizona drivers license
3. Minimum of 5 years clinical experience
4. Strong computer skills
5. Good verbal/written communication skills
6. Able to work with minimal supervision

Role Desirables
1. Previous Quality Improvement experience
2. Previous Health Plan experience

Reporting Relationships
You will report to a Manager or Supervisor.

Apply Here