UM Compliance Nurse 2

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

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

Scheduled Weekly Hours

40

Company info

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