Compliance / UM Nurse - Letters Team Central Region

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