Compliance Nurse 2 - Remote Miramar FL

Profile

Description

The Compliance Nurse 2 reviews case 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.
In addition, this position will require willingness to float with business needs within case management depts.as needed.


Required Qualifications


Unrestricted Licensed Registered Nurse, RN, in the state of Florida
3 years Care Management Experience
Experience with CGX
5 years of technical experience with MS Office Suite to include Word, Excel formatting, data entry, PowerPoint, WebEx, Outlook and OneNote
Hours: Must be willing to work a 40 hour a week Monday-Friday
Location: Must be able to travel to the local Market Office for meetings quarterly
Work Style: Remote/Work at Home
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field


Work-At-Home Requirements


WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information


Preferred Qualifications


BSN or Bachelor's degree in a related field
Utilization Management experience
Health Plan experience working with large carriers
Previous Medicare/Medicaid experience a plus
Previous experience in NABD Letters
Experience with discharge planning and/or home health or rehab
Experience working with MCG or Interqual guidelines


Additional Information

Onsite Travel

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 25m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40

Company info

Sign Up Now - ComplianceCrossing.com