Compliance Nurse Jobs

Description Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives.
We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we’re seeking innovative people who want to make positive changes in their lives, Description Healthcare isn’t just about health anymore.
It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives.
We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we’re seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole. The Compliance Nurse 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 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Responsibilities The Compliance Nurse ensures mandatory reporting is 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. This is a Part-Time Remote Position!
Candidate cannot work more than 30 hours a week, and must work more than 20 hours a week, to qualify for Part-Time Benefits. Required Qualifications: Candidate MUST be an RN (Registered Nurse) with a Bachelor's Degree (BSN) MUST have 5+ years of Nursing experience, specifically with Chart Auditing MUST be proficient with Electronic Medical Records Systems (EMR's) Active RN license in the state(s) in which the nurse is required to practice Ability to be licensed in multiple states without restrictions Proficient with Microsoft Office products including Word, Excel and Outlook Ability to work independently under general instructions and with a team Must have excellent presentation skills and the ability to effectively communicate, and review, patient chart information with high level leaders Other administrative tasks as needed Preferred Qualifications: Health Plan experience working with large carriers Previous Medicare/Medicaid experience is a plus Previous experience in Quality, Disease Management, Utilization Management, Case Management, Discharge Planning and/or Home Health or Rehab Certification in Case Management (CCM) is a plus EMR expertise (eClinicalWorks preferred) Ability to work remotely with a high degree of autonomy yet function well within a larger team unit Additional Information: Schedule: Monday – Friday, 8:00 AM – 5:00 PM (if needed, flexibility is available and can be discussed with your direct leader) This is a Part-Time Remote Position which will require quarterly travel, usually to Florida, for In-Person Team Meetings. These meetings usually last 2 days Alert: Conviva, a subsidiary of Humana, values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.
When required, an email will be sent from [email protected] with instructions to add the information into the application at Humana’s secure website. Vaccine Policy Associates are required to be fully COVID vaccinated, including booster, or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. If progressed to offer, candidates will be required to: Provide proof of full vaccination, including booster OR Provide proof of applicable exemption including any required supporting documentation Work at Home Guidance To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Scheduled Weekly Hours 40Read more about this job