A health insurance company needs applicants for an opening for a Telecommute Compliance and Auditing Nurse. Individual must be able to fulfill the following responsibilities: Review utilization management activities. Ensure adherence to policies, procedures, and regulations.
3+ years experience in a leadership/management role. Knowledge of related regulations including NCQA, HIPAA, CMS. Bachelors degree or above in a related field such as Nursing, Health Care Management, or Teaching. Proficiency in Excel, Word and Adobe Acrobat.
Nursing/Registered Nurse (RN) license is required. 5 years clinical practice experience required. 2 years of Home Health Care/Hospice Care required. Minimum of three years case management experience. Excellent analytical and problem solving skills. Bachelor's degree or equivalent experience.