Company name
Humana Inc.
Location
Omaha, NE, United States
Employment Type
Full-Time
Industry
Healthcare, Nursing, Compliance
Posted on
Jun 11, 2021
Profile
Description
The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
The Compliance Nurse 2 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. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Required Qualifications
Active RN license in the state(s) in which the nurse is required to practice
Ability to be licensed in multiple states without restrictions
Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Proficient with Microsoft Office Word, Excel and Outlook; with the ability to multi-task and work out of multiple systems
Strong verbal and written communication skills
Ability to work independently under general instructions and with a team
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
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
Education: BSN or Bachelor's degree in a related field
Utilization Review experience preferred
Knowledge of CMS regulations a plus
Previous experience in utilization management, discharge planning and/or home health or rehab
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Experience working with MCG or Interqual guidelines
Additional Information
Hours for this role are: Monday-Friday 8am-5pm or 5:30pm CST
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com