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Humana about 2 months ago
location: remoteus
Apply Now

Compliance Nursing Supervisor

locations

  • Remote Florida
  • Remote Oklahoma
  • Remote Ohio
  • Remote North Dakota
  • Remote North Carolina
  • Remote New York
  • Remote New Mexico
  • Remote New Jersey
  • Remote New Hampshire
  • Remote Nevada
  • Remote Nebraska
  • Remote Montana
  • Remote Missouri
  • Remote Mississippi
  • Remote Minnesota
  • Remote Michigan
  • Remote Massachusetts
  • Remote Maryland
  • Remote Maine
  • Remote Louisiana
  • Remote Kentucky
  • Remote Kansas
  • Remote Iowa
  • Remote Indiana
  • Remote Illinois
  • Remote Idaho
  • Remote Hawaii
  • Remote Georgia
  • Remote District of Columbia
  • Remote Delaware
  • Remote Connecticut
  • Remote Colorado
  • Remote California
  • Remote Arkansas
  • Remote Arizona
  • Remote Alaska
  • Remote Alabama
  • Remote Wyoming
  • Remote Wisconsin
  • Remote West Virginia
  • Remote Washington
  • Remote Virginia
  • Remote Vermont
  • Remote Utah
  • Remote Texas
  • Remote Tennessee
  • Remote South Dakota
  • Remote South Carolina
  • Remote Rhode Island
  • Remote Pennsylvania
  • Remote Oregon

time type: Full time

job requisition id: R-278568

Description

The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance Nursing works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to solve basic problems; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach.

Responsibilities

The Supervisor, Compliance Nursing 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 iniduals. Decisions are typically are related to schedule, plans and daily operations. Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. Ensures consistency in execution across team. Holds team members accountable for following established policies.

Required Qualifications

  • Current Unrestricted RN licensed in the state in which you reside with no disciplinary action.
  • Two or more years of prior experience in auditing, compliance oversight, and/or utilization management for an insurance health plan.
  • Two or more years of direct leadership experience (as defined by having direct reports) to include hiring, training, coaching and up to termination.
  • Knowledge of regulations governing the Medicare line of business.
  • Proficient in Microsoft Office applications including Word, Excel, Outlook and PowerPoint.
  • Strong problem solving, data-analysis, and critical-thinking skills with the ability to operate and drive progress with limited information and ambiguity.
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
  • Work hours for this position are 8AM- 5 PM Monday- Friday Eastern Time, with occasional overtime to support business needs.
  • Training: Virtual training, approximately 3 months
  • This is a Remote position; you will be expected to work in Eastern Time zone regardless of what time zone you reside in.
  • You will be expected to report to the Market office with advanced notice for meetings and/or planned work functions.

Preferred Qualifications

  • Bachelor’s Degree
  • Certification(s) relevant to area of expertise, such as certification in healthcare compliance (CHC).
  • Prior Medicare health plan experience.
  • Experience with writing and/or auditing member denial letters.
  • Experience working with and interpreting CMS regulations and criteria.

Additional Information

  • Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

  • 40