Compliance UM Nurse – Wed, Sun

🔥 13 hours ago

🐎 Kentucky, New Mexico, +3 more states – Remote

🐎 Kentucky – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🌪️ Oklahoma – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Review utilization management activities and documentation to ensure adherence to policies, procedures, and regulations • Collect and analyze data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals • Make decisions regarding work methods, occasionally in ambiguous situations, with minimal direction • Follow established guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorization requests

🎯 Requirements

• Licensed Registered Nurse (RN) in a compact state with no disciplinary action • Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure • Three (3) or more years of consecutive UM experience for a health plan OR two (2) or more years of consecutive UM auditing experience in a traditional Quality or Compliance role at a health plan OR one (1) or more years of home health utilization management experience for a health plan • Effective telephonic and virtual communication skills • Comprehensive knowledge of Microsoft Word, Outlook and Excel • Ability to work independently under general instructions and within a team • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

🏖️ Benefits

• Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Many other opportunities