Compliance Registered Nurse

2 days ago

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Humana

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Description

• Reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. • Ensures mandatory reporting completed. • Conducts and summarizes compliance audits. • Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals. • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. • Follows established guidelines/procedures.

Requirements

• Active Registered Nurse license in a state that is part of the Enhanced Nursing Licensure Compact (eNLC) compact without disciplinary action • Ability to obtain additional state licensures without restrictions • Intermediate or better proficiency using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms • Minimum of three, (3), years varied clinical nursing experience. • Minimum of one, (1), year of experience auditing and/or performing case management or utilization management chart reviews • Ability to work independently under general instructions and with a team

Benefits

• Health benefits effective day 1; • Paid time off, holidays, volunteer time and jury duty pay; • Recognition pay; • 401(k) retirement savings plan with employer match; • Tuition assistance; • Scholarships for eligible dependents; • Parental and caregiver leave; • Employee charity matching program; • Network Resource Groups (NRGs); • Career development opportunities;