RN Compliance Auditor

2 days ago

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Humana

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10,000+

Description

• Reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations • Conducts and summarizes compliance audits • Collects and analyzes data daily, weekly, monthly or as needed • Performs pre-service denial and quality assurance audits • Provides detail audit results including issues on absence of documentation, incorrect decision making, non-compliance • Responsible for internal and external communications to obtain needed information • Recommends process changes or training opportunities related to audit trends • Coordinates special compliance projects and additional tasks as determined by leadership

Requirements

• Current Unrestricted Florida RN license or Compact RN License the state where you reside • Experience with Utilization Management and Quality assurance audits • Clinical experience in an Acute Care • Proficiency in Microsoft Office Products Word, Excel, and Power Point • BSN or Bachelor's degree in a related field (Preferred) • Bilingual (English, Spanish) (Preferred) • Experience as a utilization management Auditor (Preferred) • Health Plan experience working with large carriers (Preferred) • Experience working with MCG/Interqual guidelines (Preferred) • Microsoft Outlook (Preferred) • Excellent computer skills and ability to easily navigate multiple applications (Preferred) • Skilled and/or Rehabilitation Clinical setting (Preferred)

Benefits

• Medical, dental and vision benefits • 401(k) retirement savings plan • Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) • Short-term and long-term disability • Life insurance • Many other opportunities