Compliance Utilization Management Audit Registered Nurse - Remote

Overview

The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations, preventing and detecting fraud, waste, and abuse.

In Short

• Reviews utilization management activities and documentation.
• Ensures adherence to policies and regulations.
• Conducts and summarizes compliance audits.
• Collects and analyzes data for operational metrics.
• Works independently and in a team.
• Requires an active Registered Nurse license.
• Minimum of three years clinical nursing experience.
• Experience in auditing or case management preferred.
• Remote work with occasional travel for meetings.
• Offers competitive benefits including medical and retirement plans.

Requirements

• Active Registered Nurse license in an eNLC state.
• Proficiency in Microsoft Office and troubleshooting technical issues.
• Three years of varied clinical nursing experience.
• One year of experience in auditing or utilization management.
• Ability to work independently and as part of a team.
• Preferred: Bachelor's degree in nursing (BSN).
• Behavioral health experience is a plus.
• Knowledge of Medicare/Medicaid processes.
• Certification in Case Management is a plus.
• Experience with MCG or InterQual guidelines.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability.
• Life insurance and additional opportunities.