Senior Compliance Nurse RN - WAH FL

Profile

Description

The Senior Compliance Nurse reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Senior Compliance Nurse work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Compliance Nurse 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. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Additional Job Description

Required Qualifications

RN with active license in FL.

3 years of prior experience in utilization management, and/or health plan compliance or auditing

Demonstrated problem solving skills; ability to give direction and make sound business decisions.

Ability to communicate and collaborate across multi-business units within the organization.

Strong communication skills, both verbal and written.

Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook

Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

WAH requirements: 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. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

BSN or Bachelor's degree in a related field.

Prior experience working with delegated providers and/or vendors.

Strong preference for Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testingPrior Medicare health plan experience.

Experience working with and interpreting CMS regulations and criteria.

Additional information

Schedule: Monday-Friday from 8 am to 5pm, with necessary overtime as the business demands for it.

Training: Virtual training, approximately 3 months.

Work Location (Address): WAH from FL only.

% Travel: 10-15%, approximately three or four times a year for onsite audits with delegated vendors

Language Proficiency Testing: Any Humana associate who speaks with a member in a language other than Spanish and/or English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com