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Job Profile
Compliance Nurse 2
Job Level
Professional 2
Become a part of our caring community
The Compliance 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.
Please Note: This role will follow a four-day, 10-hour shift schedule within a Wednesday through Sunday work week. The assigned schedule will be either Wednesday through Saturday or Thursday through Sunday, with work hours scheduled between 8:00 a.m. and 8:00 p.m. Eastern Time.
The Compliance Nurse 2collects and analyzes data daily, weekly,monthlyor as needed to assess outcome and operational metrics for the team and individuals. Understands department, segment, and organizational strategy and operatingobjectives, including their linkages to relatedworkstreams. Makes decisionsregardingown work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.Assignments are varied and often complex, requiring independent judgment, critical thinking, and interpretation of guidelines to determineappropriate coursesof action.Follows established guidelines, regulatory turnaround times, andproceduresfor processing QIO fast track appeals and expedited authorization requests.
Use your skills to make an impact
Work-At-Home Requirements
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Referral Bonus Information
This requisition is not eligible for a referral bonus.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
