RN Auditor, Utilization Management/Clinical Compliance - Doral, FL

Humana Inc. West Palm Beach , FL 33409

Posted 10 months ago

Description

The Compliance/Audit 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.

Responsibilities

The hours of this role are Mon-Fri, 8am-5pm est. The work location will be the office in Doral. FL for the first 6 months and will then transition to work at home with the flexibility to work from home 2 days a week Occasional overtime as needed based on the needs of the business.

The Compliance/Audit 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. 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. Follows established guidelines/procedures.

Required Qualifications

  • Active RN license in FL without restrictions

  • Ability to be licensed in multiple states without restrictions

  • Prior clinical experience in an acute care, skilled or rehabilitation clinical setting

  • Experience in utilization management

  • Excellent computer skills and ability to easily navigate multiple applications

  • Strong communication skills, both verbal and written

  • Ability to work independently under general instructions and with a team

Preferred Qualifications

  • BSN or Bachelor's degree in a related field

  • Health Plan experience working with large carriers

  • Previous experience as a UM Auditor

  • Experience working with MCG guidelines

  • Strong preference for bilingual (able to read and write in Spanish)

Additional Information

As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.

If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.

Scheduled Weekly Hours
40


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RN Home Health
New!

Interim Healthcare

Posted Today

VIEW JOBS 2/18/2020 12:00:00 AM 2020-05-18T00:00 Looking for a successful company that is established and a position with lots of room for growth? We at Interim Healthcare have been around for over 50 years and are continuing to grow. Our very busy Home Health agency is looking for an experienced RN Case Manager to join our Interim Home Health team in our West Palm Beach office. Help us continue to provide exceptional community-based home care to our patients. We make a difference in the lives of not only our patients but our employees too. APPLY TODAY ! Responsibilities: * RN is responsible for all aspects of patient care and should have clear knowledge of the nursing scope of practice. * Creates and oversees patient plan of care across all disciplines. * Coordinate referral & patient care services for Medicare and Managed Care patients. * Comfortable with entering OASIS, POC/485 data into EMR system. * Accurate review of POC/485's, orders and all associated documentation in patient files. * Ensuring and maintaining compliance with regulations and agency policies. * Assist in scheduling and staffing of patients when needed. * Work with Case Manager team to develop, implement and update plan of care for all patients. * Effective communicator with physicians & patients to ensure standards of excellence in patient care. * May be asked on occasion to perform field visits. * Timely submission of computer clinical notes and other documentation after field visits. Job Requirements Requirements: * Minimum of 2 years Medicare/Managed Home Care experience * Experience/Knowledge with OASIS * Knowledge of Home Healthcare regulations * Florida Registered Nurses License * CPR Certification * Current credentials and license in good standing * Valid driver's license * Ability to multi-task and prioritize effectively Job Benefits * Locally Owned and Operated * Competitive Salary and Benefits * Paid Time Off * 401K * Health Coverage * Dental Coverage * Paid Holidays * Free CEUs * Vision Insurance Company Overview Interim HealthCare is America's leading provider of home care, hospice and healthcare staffing. We offer one of the most comprehensive selections of career opportunities in the industry ranging from per diem to full-time. If you're looking for a stable career opportunity, look no further. We offer the freedom of a flexible work schedule combined with the security of working for an established company. Nationally, Interim HealthCare has been providing great jobs to great people for 50 years and there are more than 300 offices across the country. That kind of stability combined with our commitment to integrity makes us your perfect career partner. Interim HealthCare is an Equal Opportunity Employer. Each Interim HealthCare location is independently owned and operated. ©2019 Interim HealthCare Inc. Other Info * Job City: West Palm Beach * Job State: FL * Employee Type: Full Time * Min Salary: $65,000.00 * Max Salary: $75,000.00 * Compensation Type: Annually Interim Healthcare West Palm Beach FL

RN Auditor, Utilization Management/Clinical Compliance - Doral, FL

Humana Inc.