Humana (501+ Employees, 2 Yr Employee Growth Rate)
time type: Full time
job requisition id: R-278568
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.
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 individuals. 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.
- 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.
- 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.
- 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