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.

Required Qualifications

• 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

Preferred Qualifications

• 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)

Additional Information

Workstyle – Remote work at Home with the ability to travel to the office for meetings and trainings as needed.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.