RN- Sr Market Clinical Engagement Professional - Houston/San Antonio Market

Profile

Job Information
Humana
RN- Sr Market Clinical Engagement Professional - Houston/San Antonio Market
in
San Antonio
Texas
Description
The RN Senior Market Clinical Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to promote and improve clinical performance and quality outcomes within assigned geographic markets and /or assigned provider relationships. Influences and consults on matters related to utilization metrics, care delivery programs and member-level care opportunities, to promote population health approach to patient care. The RN Senior Market Clinical Engagement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Responsibilities
Job Description
The RN Senior Market Clinical Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to promote and improve clinical performance and quality outcomes within assigned geographic markets and /or assigned provider relationships. Influences and consults on matters related to utilization metrics, care delivery programs and member-level care opportunities, to promote population health approach to patient care. The RN Senior Market Clinical Engagement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Responsibilities
Lead and work alongside a team of clinical consultants
Assist in the development of departmental goals and determine objectives, approach and tactical operations of clinical team, ensuring accountability and consistency in execution
You will engage and collaborate with providers and clinical personnel, to identify opportunities to enhance care delivery and improve the health and wellbeing of Humana members
Participate in internal Provider Engagement strategy and /planning meetings
Consult with internal resources to identify opportunities for improving provider/member outcomes related to clinical utilization, disease management program participation, quality care gaps and social determinates of health
Identify both population health and member level opportunities to improve health outcomes, identification of Social Determinants of Health (SDOH) needs and barriers and drive positive clinical performance
Facilitate external discussions and workgroups with medium to large provider practices on improvement opportunities, development and implementation of tactical improvement initiatives, workflow development, and monitoring of outcomes
Identify, leverage and deploy tools, resources and vendor relationships to improve member outcomes
Required Qualifications
Licensed Registered Nurse (RN) with no disciplinary action.
Comprehensive knowledge of all Microsoft Office application with proficiency in Excel, PowerPoint and Word
Proven experience in completing efficient health related research, with associated analysis and drawn conclusions
Excellent communication skills, written and verbal
Comfortable facilitating clinical workgroup meetings and leading external clinical discussions
Strong organizational skills
Demonstrated ability to manage multiple projects at once and meet deadlines
Passionate about working in a team environment with shared accountability to improve consumer experience and health outcomes
Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
Preferred Qualifications
Quality Improvement experience including HEDIS and STARs
Bachelor's degree
Prior experience leading teams or influencing individuals to achieve objectives
Knowledge of Medicare policies, processes and procedures
Experience using Microsoft Teams application
Knowledge of Medicare policies, processes and procedures
Managed Care Experience a plus
Comprehensive knowledge of Humana systems including CGX, CRM, Compass, Rosalind
Additional Information
Must have the ability to travel throughout the state of Texas up to 10%-15% of the time both a combination of local and overnight travel
Currently this position is not doing any traveling as we adhere to our company travel restriction policy due to COVID-19
Preference would be to reside within a commutable distance to the Houston or San Antonio area
For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster or commit to testing protocols
*OR  *
Provide proof of applicable exemption including any required supporting documentation
​​Medical, religious, state, and remote-only work exemptions are available
Scheduled Weekly Hours
40

Company info

Sign Up Now - NursingCrossing.com