Compliance Registered Nurse
CA
- Eligibility
- RNGeneral
- Shift
- 8-hour 8 hour
- Hours a week
- 40 hrs a week
Posted Jun 18 · Not open to new grads
What the listing says
Role
- Schedule
- 8-hour 8 hour · 5 a week · 40 hours
- Weekends
- Weekends required
- Term
- Permanent
- Setting
- Telehealth
- Accepts
- RN
- Experience
- 3+ years
Ratio not posted. Ask in the interview.
Pay
- Similar roles post
- Similar CA staff roles post $42/hr to $69/hr
CA staff postings that state pay run $33/hr to $86/hr, the middle half $42/hr to $69/hr, across 1985 postings.
We don’t have a pay range for this role yet.
We can help you find the number.
About this role
Become a part of our caring community and help us put health first
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.
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.
Read the full posting
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. Reviews denial letters issued to members and providers to ensure compliance with accreditation entities and State contractual requirements.
Follows established guidelines/procedures.
Use your skills to make an impact
Required Qualifications
Active Registered Nurse license in a state that is part of the Enhanced Nursing Licensure Compact (eNLC) compact without disciplinary action
Ability to obtain additional state licensures without restrictions
A minimum of three years varied clinical nursing experience.
2 years of experience in utilization management with MCG Guidelines
Ability to work independently under general instructions and with a team.
Intermediate or better proficiency using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
Preferred Qualifications
BSN
Behavioral Health Utilization Management
Health Plan experience working with large carriers
Previous Medicare/Medicaid experience a plus
Experience with National Committee for Quality Assurance (NCQA) requirements
Workstyle: Remote work at Home
Location: Must reside in a state that is part of the Enhanced Nursing Licensure Compact (eNLC)
Schedule
Must be able to work an 8-hour shift Monday through Friday with end of shift time of 6:00 PM Eastern Time
Ability to work weekends and holidays on a rotating schedule. (about 1 weekend day per month, and 2 holiday per year)
Work at Home Guidance To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is required.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Modern Hire Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first-round interview, you will 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 in a Modern Hire Voice interview. In this interview, you will listen to a set of interview questions over your phone, and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
SSN Alert
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.
Benefits
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families
“Ability to obtain additional state licensures without restrictions A minimum of three years varied clinical nursing experience. 2 years of experience in utilization management with MCG Guidelines Ability to work indepen…” · from this posting
Requirements
- Active Registered Nurse license in a state that is part of the Enhanced Nursing Licensure Compact (eNLC) compact without disciplinary action
- Ability to obtain additional state licensures without restrictions
- A minimum of three years varied clinical nursing experience.
- 2 years of experience in utilization management with MCG Guidelines
- Ability to work independently under general instructions and with a team.
- Intermediate or better proficiency using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
Show all 13 requirementsShow fewer
- Preferred Qualifications: BSN
- Preferred Qualifications: Behavioral Health Utilization Management
- Preferred Qualifications: Health Plan experience working with large carriers
- Preferred Qualifications: Previous Medicare/Medicaid experience a plus
- Preferred Qualifications: Experience with National Committee for Quality Assurance (NCQA) requirements
- Preferred Qualifications: Workstyle: Remote work at Home
- Preferred Qualifications: Location: Must reside in a state that is part of the Enhanced Nursing Licensure Compact (eNLC)
Place
- City
- CA
- State price level
- 11% above the national average
California index 110.7, where 100 is the national average.
Cost figures from U.S. Bureau of Economic Analysis · 2024 Regional Price Parities.
How this role fits you
About the employer
Worth asking
The posting doesn’t answer these. Good ones to ask a recruiter or in the interview.
- Can you walk me through base pay range and differentials?
- What should I expect for holiday, call, and rotation?
- What orientation, preceptor time, and ongoing unit support are included?
- How are patient load, floating, and staffing support handled day to day?
