Senior Compliance Registered Nurse

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Job Information
Humana
Senior Compliance Registered Nurse
in
Troy
Michigan
Description
Humana Healthy Horizons in Ohio is seeking a Senior Compliance Nurse. This position ensures mandatory reporting for Case Management and Utilization Management audit team is completed timely and accurately.
Responsibilities
Senior Compliance Nurse 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. Work is performed without direction with the ability to exercise considerable latitude in determining objectives and approaches to assignments.
Position Responsibilities:
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,
Requires minimal direction and receives guidance where needed.
Follows established guidelines/procedures.
Required Qualifications
Bachelor's Degree
Active Registered Nurse, RN, license in the state of Ohio with no discrepancies
Ability to be licensed in multiple states without restrictions
5 years varied clinical nursing experience
1 year team lead oer supervisory experience
2 years Compliance Auditing experience
Health Plan or Medical Practice experience
Proficient with Microsoft Office products including Word, Excel and Outlook, multiple systems, platforms, and ability to troubleshoot and resolve general technical issues.
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
Additional Requirements/Adherence
Workstyle - Remote work at Home
Location: Primary Ohio
Alternate Locations: Kentucky, West Virginia, Indiana, Michigan, Pennsylvania
Work Days/Hours: Monday - Friday; 8:00am - 5:00pm.
Travel: 5-10% travel in Ohio as needed to support business needs.
Remote work at home Requirements
Private room with a door and a lock to for privacy during works.
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
MSN or equivalent degree
CCM certification
Previous Medicare/Medicaid experience a plus
Previous experience or knowledge of NCQA accreditation requirements a plus
Additional Information
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed)
inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Covid Compliance Policy
For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster or commit to testing protocols
*OR  *
Provide proof of applicable exemption including any required supporting documentation
​​Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours
40

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