Compliance Audit Nurse

Humana • Oklahoma City, OK

20h • $71,100 - $97,800 • Remote

About The Position

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

Requirements

• 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

Nice To Haves

• 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)

Responsibilities

• Auditing care management activities and documentation to ensure adherence to policies, procedures, and regulations.
• Ensuring mandatory reporting is completed.
• Conducting and summarizing compliance audits.
• Collecting and analyzing data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals.
• Understanding department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Following established guidelines/procedures.

Benefits

• medical
• dental
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level