Internal Audit – Nurse Auditor

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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

• Perform audit projects and consulting engagements following established methodology within budgeted timeframes • Serve as the clinical subject matter expert for CenterWell, Care Management, Utilization Management, and other healthcare delivery functions • Partner with audit professionals during audit planning, testing, and reporting • Evaluate key processes, controls, and compliance with regulatory, contractual, and organizational requirements • Review clinical documentation, operational workflows, and quality management activities • Identify potential risks and evaluate control effectiveness • Recommend process improvements that enhance compliance, quality, and operational performance • Communicate audit and consulting results through written reports and oral presentations to management

🎯 Requirements

• Active, unrestricted RN license • Three (3) or more years of clinical nursing experience • Demonstrated knowledge of care management, utilization management, population health, or healthcare operations • Experience evaluating clinical processes, internal controls, compliance programs, clinical documentation, healthcare operations, and workflow effectiveness • Knowledge of healthcare regulations, accreditation standards, and industry best practices, including CMS, NCQA, URAC, or state and federal requirements • Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint • Strong written and oral communication skills • Ability to prepare clear, concise reports and collaborate effectively with stakeholders • Preferred: Case Management (CCM), Utilization Management (CPUM), Internal Auditing (CIA), or related discipline • Preferred: Experience in managed care or health care administration • Preferred: Experience participating in audits, assessments, quality reviews, or compliance monitoring activities • Minimum download speed of 25 Mbps and upload speed of 10 Mbps • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • 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 • Work-from-home arrangement • Team engagement meetings and training opportunities