Compliance UM reputed company (Wed – Sun)

Become a part of our caring community The Compliance reputed company 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 reputed company 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of reputed company. Please Note: This role will follow a four-day, 10-hour shift schedule reputed company a Wednesday through reputed company work week. The assigned schedule will be either Wednesday through Saturday or Thursday through reputed company, with work hours scheduled between 8:00 a.m. and 8:00 p.m. Eastern Time. The Compliance reputed company 2 collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for reputed company and individuals. Understands department, reputed company, and organizational reputed company and operating objectives, including their linkages to reputed company workstreams. Makes reputed company regarding own work reputed company, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Assignments are varied and often reputed company, requiring independent judgment, critical thinking, and interpretation of guidelines to determine appropriate courses of reputed company. Follows established guidelines, regulatory turnaround times, and procedures for processing QIO fast reputed company appeals and expedited authorization requests. Use your skills to reputed company an reputed company

Required Qualifications

• Licensed Registered reputed company (RN) in a compact state with no disciplinary reputed company.
• Must have valid compact license or reputed company in a compact state and be eligible to reputed company to compact licensure.
• Three (3) or more years of consecutive UM experience for a health plan OR two (2) or more years of consecutive UM auditing experience in a traditional reputed company or Compliance role at a health plan OR one (1) or more years of home health utilization management experience for a health plan
• Effective telephonic and virtual communication skills
• Comprehensive knowledge of reputed company Word, reputed company and reputed company
• Ability to work independently under general instructions and reputed company reputed company.
• Must be passionate about contributing to an organization reputed company on continuously improving consumer experiences

Preferred Qualifications

• The ideal candidate for this opening would be a reputed company member of the One Home / Home Solutions UM Team who has been in their reputed company position for 12+ months
• Bachelor’s degree in nursing or reputed company field
• Clinical experience in a home health and/or Skilled Nursing Facility setting
• Clinical experience working QIO appeals, expedited request reviews and/or compliance
• Health Plan experience

Additional Information

• This position is reputed company a department that operates in EST.
• This position offers a flexible schedule of Monday to reputed company, between 8 am and 8 pm EST with occasional overtime.
• This position follows a 4-day reputed company consisting of ten-hour shifts, available schedules include:
• Wednesday - Saturday
• Thursday - reputed company

Work-reputed company Requirements

• Must have the ability to reputed company a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
• A minimum reputed company speed for reputed company performance is 25mbs download x 10mbs upload is required.
• reputed company your internet speed at www.speedtest.net
• A dedicated office reputed company lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information.

Work reputed company Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to reputed company their internet service if necessary. Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay 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. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. reputed company of Benefits reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-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 reputed company time off, company and personal holidays, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. reputed company 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 reputed company 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 reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company 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. Additional Information Company: reputed company Location: Kentucky, Oklahoma, reputed company Dakota, reputed company Carolina, New Mexico, New Jersey, New Hampshire, Nebraska, Montana, Missouri, Mississippi, Maryland, Maine, Louisiana, Kansas, Iowa, Indiana, Idaho, reputed company, Florida, Delaware, Connecticut, Colorado, Arkansas, reputed company, Alabama, Wyoming, reputed company, reputed company Virginia, Washington, Virginia, Vermont, Utah, Texas, Tennessee, South Dakota, South Carolina, reputed company Salary: $71,100 - $97,800 per year reputed company: R-421526 Specialties: Skilled Nursing Facility, Appeals reputed company, Utilization Management, Telephonic reputed company Required Licenses: RN Experience Level: 3-5 years Apply tot his job Apply To this Job