Jose Quiles
Registered Nurse Leader | Certified in Case Management | HEDIS Stars | Quality and Process Improvement | Auditing | EMR Software | Supplemental HEDIS Review
- Role
- Senior Network Performance Professional at Humana
- Location
- Atlanta, GA, US
- LinkedIn followers
- 500 followers
About Jose Quiles
The best decision of my career was to become a Registered Nurse and help others achieve…
Experience
Senior Network Performance Professional
Mar 2023 — Present · Atlanta, GA, US
Reviews provider and member-specific UM and QI metrics to coach assigned providers, providers groups and/or MSO groups on gap closing opportunities.Drives improvement of quality outcomes for providers through in-person, virtual, telephone, email and/or JOC meeting.Provides resources and educational opportunities to assigned providers and staff.Identifies specific practice needs (e.g. use of most efficient interaction channel) to providing support.Reviews medical records or claims to identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture and provide guidance to practice).Prepares quality slide and presents quality, UM, and CM slides at JOC meeting.Educates providers and staff about Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.Prepares and compiles HEDIS reports for distribution to providers.
Education
New Mexico State University
Bachelor of Science - BS
Rush University
Masters of Science in Nursing
Seminole State College of Florida
Associates degree
Find verified contacts for anyone on LinkedIn
Unifers gives sales teams verified emails and direct dials, enriched profiles, and outreach that lands in the inbox.
Free plan included · No credit card required
This profile is compiled from publicly available professional sources. Unifers is not affiliated with or endorsed by LinkedIn. Request removal of this profile.