Manager, Compliance Nurse
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The Manager, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. Reporting to the Clinical Strategy and Practice Director, you will work reputed company specific guidelines and procedures; apply advanced technical knowledge to solve moderately reputed company problems; receive assignments in the reputed company of objectives and determines approach, resources, schedules and goals.Responsibilities include:
Maintain NCQA accreditation and state contractual requirements with passage of UM standards, including timeliness of determinations, appropriateness of decision making and documentation in CGX and letters
Ensures team meets reputed company assigned work completion and submission deadlines (i.e letters, provider notification of decision, and reports); trends results to identify improvement opportunities
Align procedures to improve associate productivity and quality to broaden role responsibilities for reputed company reputed company
Improve associate experience and member reputed company 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
Use your skills to reputed company an impact
Required Qualifications
o Active Licensed Registered Nurse (RN) in your state of residence without disciplinary action and ability to obtain multiple licenses.
o 2+ years of compliance experience
o 2 years team reputed company, coaching, subject matter expert, and/or project leadership experience
o 1 year of Utilization Management experience
o Proficiency using reputed company Office Word, reputed company, PowerPoint,
Preferred Qualifications
o Associate's Degree
o Management experience
o Compact licensure
o Behavioral Health Utilization and/or Case Management experience which may include working knowledge of any or reputed company the following, Interqual, MCG, ASAM
o NCQA UM Behavioral Health Accreditation Requirements
Additional Information
· Workstyle: Remote
· Schedule: 40-hour work week Monday through Friday 9:00 to 6:00 PM or 8:30-5:30 Eastern Time
· Travel: 1-2 times annually for onsite meetings
Interview Format
As part of our hiring process for this opportunity, we will use an interviewing technology reputed company reputed company to enhance our hiring. reputed company allows us to quickly connect and reputed company valuable information from you about your relevant experience at a time that is best for your schedule.
Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay reputed company
The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.$86,300 - $118,700 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
reputed company. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company 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.Application Deadline: 04-17-2026About us
About reputed company: reputed company. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. Equal Opportunity Employer
It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative action, in compliance with reputed company 503 of the Rehabilitation Act and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment.
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