RN Compliance Nurse 2 - WAH AZ CO or NM

Profile

Description

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.

Responsibilities

The Compliance 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 the state(s) in which the nurse is required to practice
Ability to be licensed in multiple states without restrictions
3 or more years of experience in Utilization Management
Knowledge and experience with Medicare guidelines
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 experiences


Preferred Qualifications


BSN
Health Plan experience working with large carriers
Certification in MCG


Additional Information

Scheduled Weekly Hours

40

Company info

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