Become a part of our caring community and help us put health first
 

The Compliance Registered Nurse 2 role directly supports the organization's ability to maintain contractual compliance, achieve and sustain NCQA accreditation, and mitigate risk through diligent oversight, policy enforcement, and ongoing education. The role of a Compliance Nurse will be to manage state contracts, policies, NCQA accreditation requirements, and monthly auditing. This is critical in ensuring organizational adherence to regulatory standards and internal protocols. This position is responsible for the implementation, oversight, and continuous monitoring of compliance with both state and federal regulations, as well as industry accreditation requirements such as those established by the National Committee for Quality Assurance (NCQA).

In this role you will ensure 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.

Use your skills to make an impact
 

Required Qualifications

• Active RN license in the state of South Carolina

• 1-2 years’ experience with National Committee for Quality Assurance (NCQA) and state audits

• Proficient with Microsoft Office products including Word, Excel and Outlook

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

• Must be passionate about contributing to an organization focused on continuously improving consumer experience

Preferred Qualifications

• BSN

• Health Plan experience working with large carriers

• Previous Medicare/Medicaid experience a plus

• Previous experience in utilization management, case management, discharge planning and/or home health or rehab

• Certification in Case Management a plus (CCM)

• Knowledge with MCG or Interqual guidelines

Additional Information

Note: There will be occasional travel to the office for team meet ups at least two times per year.

Work-At-Home Requirements

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.

Interview Format

As part of our hiring process for this opportunity, we will be using exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first-round interview, you will receive an email correspondence inviting you to participate in a HireVue interview.  In this interview, you will receive a set of interview questions over your phone, and you will provide recorded or text message responses to each question. For best interview experience use a computer over a phone.  You should anticipate this interview to take about 15-20 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Humana Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

Health benefits effective day 1
Paid time off, holidays, volunteer time and jury duty pay
Recognition pay
401(k) retirement savings plan with employer mat