Compliance Nurse 2 Author by Humana

Profile

Description

Author, recently launched by Humana, is a service experience designed to meet the whole-health needs of the people we serve. Created to innovate with the speed and agility of a modern start-up and backed by the insights and scale of Humana, Author is pioneering a customer-centered experience designed to foster trusting relationships with members to help them achieve their best health.

Dedicated to simplifying the healthcare experience and helping people navigate their healthcare journey, Author is leveraging digital technologies to eliminate fragmentation and systematic friction for members and providers.

We are seeking individuals who are passionate about solving tough problems as we forge a new path for the healthcare industry. As a member of the Author team, you will have the opportunity to make a difference in the lives and health of the members we serve.

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


Bachelor's degree
Less than 5 years of technical experience
Active RN license in the state(s) in which the nurse is required to practice
Ability to be licensed in multiple states without restrictions
A minimum of three years varied nursing experience
Proficient with Microsoft Office products including Word, Excel and Outlook
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


Preferred Qualifications


BSN
Health Plan experience working with large carriers
Previous Medicare/Medicaid experience a plus
Previous experience in utilization management, case management, discharge planning and/or home health or rehab
Certification in Case Management a plus (CCM)
Experience working with MCG or Interqual guidelines


Additional Information

#Author

Scheduled Weekly Hours

40

Company info

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