Note: The job is a remote job and is open to candidates in USA. Humana is a healthcare company offering insurance and healthcare services. The Internal Audit – Nurse Auditor serves as a clinical subject matter expert supporting audit projects and consulting engagements across healthcare operations, evaluating processes, controls, compliance, and documentation. The role also prepares audit reports and recommendations to improve quality and operational performance.
Responsibilities
- Perform audit projects and consulting engagements following established methodology within budgeted timeframes
- Serve as the clinical subject matter expert supporting Internal CenterWell, Care Management, Utilization Management, and other healthcare delivery functions
- Partner with audit professionals to provide clinical insight during audit planning, testing, and reporting activities, helping evaluate the effectiveness of key processes, controls, and compliance with regulatory, contractual, and organizational requirements
- Reviews clinical documentation, operational workflows, and quality management activities to identify potential risks, evaluate the effectiveness of controls, and recommend process improvements that enhance compliance, quality, and operational performance
- Communicate the results of audit and consulting projects with written reports and oral presentations to management
Skills
- An active, unrestricted, RN license
- Three (3) or more years of clinical nursing experience, with demonstrated knowledge of care management, utilization management, population health, or healthcare operations
- Experience evaluating clinical processes, internal controls, compliance programs, clinical documentation, healthcare operations, and workflow effectiveness to assess regulatory compliance, quality outcomes, and operational performance
- Knowledge of healthcare regulations, accreditation standards, and industry best practices, including CMS, NCQA, URAC or state and federal requirements
- Proficient in Microsoft Office Suite, including Word, Excel, and PowerPoint with the ability to support operational and audit activities
- Strong written and oral communication skills, with the ability to prepare clear, concise reports and collaborate effectively with stakeholders at all levels of the organization
- Up to 5% travel is required for team engagement meetings, which may occur outside your state of residence
- Monday – Friday; 8:00AM – 5:00 PM Eastern Time (ET)
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
- Case Management (CCM), Utilization Management (CPUM), Internal Auditing (CIA), or related discipline
- Experience in managed care or health care administration
- Experience participating in audits, assessments, quality reviews, or compliance monitoring activities within care management, utilization management, or healthcare operations
Benefits
- This is a remote position.
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
- This job is eligible for a bonus incentive plan.
Company Overview
Company H1B Sponsorship