Clinical Advisor RN - Quality Review

Job Description: Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly traded health benefits companies, with approximately 9 million medical members. 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.

Over its 45-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.


Clinical Advisor - Quality Review
Location: Milwaukee
- Investigate clinical quality complaints.
- Promote clinical programs, provide clinical data and address physician issues in provider offices
- Perform accurate data collection for HEDIS, medical record review, and clinical studies
- Contribute to development of clinical interventions based on HEDIS results and NCQA accreditation requirements

Requirements:
- Must be bachelor's prepared RN.
- Quality management experience
- Excellent verbal and written skills
- Analytical skills and attention to detail

Preferences:
- CPHQ certification.
- Computer proficient, especially in Microsoft Office software

Searchable Keywords: Clinical Advisor RN - Quality Review / gj-mo

Minimum Education Required: Associate

Years of Experience Required: At Least 3 Years

Expected Travel Time: None