Compliance Audit Nurse

About the role

The Compliance Audit Nurse is responsible for auditing care management activities and documentation to ensure adherence to policies, procedures, and regulations. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Key responsibilities

• Ensure mandatory reporting completed
• Conduct and summarize compliance audits
• Collect and analyze data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas
• Follow established guidelines/procedures

Required qualifications

• Bachelor's degree in Nursing
• Active Registered Nurse, RN, license in the state of Oklahoma with no discrepancies
• 3+ years clinical nursing experience
• 1+ years Prior Compliance Auditing experience in healthcare
• Proficient with Microsoft Office products including Word, Excel and Outlook
• Must reside in the state of Oklahoma

Preferred qualifications

• Previous Medicare/Medicaid experience
• Previous experience in utilization management, case management, discharge planning and/or home health or rehab
• Certification in Case Management a plus (CCM)

Work arrangement

• Remote work at Home with the ability to travel to the office for meetings and trainings as needed
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Occasional travel to Humana's offices for training or meetings may be required

Work at home requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested
• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary

Schedule

Scheduled Weekly Hours: 40

Pay

$71,100 - $97,800 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Benefits

Humana offers medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.