Remote Manager, Compliance Nursing RN (Pacific Southwest Region)

Humana

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Location: Phoenix, AZ
Location Type: Phoenix – Remote
Additional Location: CO; NV; NM;
Schedule: Full_time
Req: R-312865

Description

 

The Manager, Compliance (UM) conducts and summarizes compliance audits. The Manager, Compliance (UM) works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

 

Responsibilities

The Manager, Compliance Nursing (UM):

  • Will review daily corporate reports to manage case compliance concerns, reviewing denial letters for compliance, education HSO leaders and clinical team to compliance changes and updates.
  • Align procedures to improve associate productivity and quality to broaden role responsibilities for optimal outcomes.
  • Improve associate experience and member outcomes through innovation, identifying new ways of working using technology enhancements to streamline processes and create administrative efficiencies.
  • Requires cross departmental collaboration, and conducts briefings and area meetings, maintaining frequent contact with other managers across the market.

Required Qualifications

  • Licensed Registered Nurse (RN) in the appropriate state(s) with no disciplinary action
  • Ability to be licensed in multiple states without restrictions
  • Utilization Management experience
  • Progressive clinical experience preferably in a clinical setting
  • Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook
  • Strong attention to detail, excellent time management and organizational skills
  • Excellent communication skills both verbal and written

Preferred Qualifications

  • Bachelor’s degree (BSN)
  • 2 years of Compliance related experience
  • Supervisory experience a plus
  • Health Plan experience
  • Prior Medicare / Medicaid experience

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

 

Additional Information

  • Hours for this role are: Monday-Friday 8am-5pm PST
  • 10% based on a business need
  • This role may have 3 direct reports
  • This is a remote position

#LI-Remote

 

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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$84,600 – $116,300 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

 

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.