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Job Information

AdventHealth Senior Health Plan Nurse in Maitland, Florida

Description

Health Plan Registered Nurse AdventHealth Corporate

Location Address: 101 Southhall Lane Maitland, FL 32751

Top Reasons To Work At AdventHealth Corporate

  • Great benefits

  • Immediate Health Insurance Coverage

  • Career growth and advancement potential

Work Hours/Shift:

  • Full-Time, Mon - Fri

You Will Be Responsible For:

  • Understand populations, quality program and contractual deliverables

  • Makes recommendations on opportunities to identify best clinical practices

  • Develop pathways, guidelines and protocols to improve quality and obtain optimal utilization rates

  • Understands and interprets clinical data

  • Serves as the clinical subject matter expert

  • Monitors and evaluates operational effectiveness of the clinical programs

  • Develops and implements projects in collaboration with other disciplines in support of the Quality program

  • Work collaboratively to prioritize work to meet quality and contractual goals

  • Keep abreast of the clinical evidence-based guideline recommendations by various external subject matter expert entities

  • Make recommendations on updates and changes to health system to include protocols, tools and documents

  • Other duties as assigned

Qualifications

What You Will Need:

  • Bachelor’s degree in a Nursing

  • Registered Nurse with current licensure to practice professional nursing in the State of Florida

  • Minimal 3 years recent clinical experience

Job Summary:

The Health Plan RN is part of the PHSO multi-disciplinary team that is responsible for improving both the individual health and wellness of program participants and the overall health status of a client's population. As part of the PHSO Quality team the Health Plan RN role is focused on improving clinical performance and optimal utilization rates across all network regions by understanding data, by population in order to identify key clinical areas to drive improvement and to reduce cost or variation in how care is designed and delivered.

The Health Plan RN will review, and track clinical, and utilization data from multiple sources in order to identify opportunities and determine the activities needed to meet quality targets and employer and payor contractual goals across the continuum. Working collaboratively with the Chief Medical Officer, Data Analyst team and Quality leaders, the Health Plan RN will implement best practices and develop protocols, procedures and guidelines to achieve the contractual goals of the assigned populations. Participates in process improvement initiatives to drive performance across all products, services and networks.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

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