Compliance Nurse 2

Conviva Senior Primary Care; South Carolina; Remote; USD 71,000 - 98,000; Full time

Job summary

Join a forward-thinking organization as a Compliance Nurse 2, where you will play a crucial role in ensuring adherence to health policies and regulations. This remote position offers the opportunity to work independently while collaborating with a dedicated team. You will review and analyze compliance activities, conduct audits, and support a caring community focused on holistic health for seniors. Enjoy a flexible schedule and comprehensive benefits while making a meaningful impact in the lives of others.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Plan

Paid Time Off

Disability Insurance

Life Insurance

Qualifications

• Active RN license in the state(s) of practice.
• Ability to be licensed in multiple states without restrictions.

Responsibilities

• Review utilization management activities for compliance.
• Conduct and summarize compliance audits.
• Collect and analyze data to assess outcomes.

Skills

Nursing Experience

Compliance Nursing

Clinical Documentation Improvement

Communication Skills

Microsoft Office Proficiency

Education

Bachelor’s degree in nursing (BSN)

Job description

Join to apply for the Compliance Nurse 2 role at Conviva Senior Primary Care.

2 days ago Be among the first 25 applicants.

Conviva Senior Primary Care provided pay range

This range is provided by Conviva Senior Primary Care. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$71,100.00/yr - $97,800.00/yr

Become a part of our caring community and help us put health first

The Compliance Nurse 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 role involves varied work assignments, requiring interpretation and independent decision-making.

The Compliance Nurse 2 ensures mandatory reporting is completed, conducts and summarizes compliance audits, and collects and analyzes data to assess outcomes and operational metrics. Understands department, segment, and organizational strategies and makes decisions with minimal guidance, following established guidelines.

Required Qualifications

• Bachelor’s degree in nursing (BSN)
• At least three years of varied nursing experience
• Active RN license in the state(s) of practice
• Ability to be licensed in multiple states without restrictions

Preferred Qualifications

• Minimum of 3 years of Compliance Nursing experience
• Knowledge of Clinical Documentation Improvement (CDI)
• Experience working with large health plans, Medicare/Medicaid, chronic disease management, utilization management, case management, discharge planning, home health, or rehab
• Risk adjustment and auditing experience
• Coding background
• Ability to work independently and in a team
• Strong communication skills and proficiency with Microsoft Office

Additional Information

• This position is 100% remote, with at least one team meeting and occasional travel.
• Typical hours are M-F 8-5, with flexibility upon manager approval.

Travel to Humana's offices may be required for training or meetings.

Schedule and Compensation

40 hours per week. The pay range reflects an estimate for full-time employment and may vary based on location and experience. This role is eligible for a bonus based on performance.

Benefits

Humana offers comprehensive benefits, including medical, dental, vision, 401(k), paid time off, disability, life insurance, and more, supporting your well-being and work-life balance.

About Us

Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, chronic condition management, and more, focusing on holistic health. Part of CenterWell, a Humana company, it emphasizes whole-person health and community well-being.

Equal Opportunity Employer

Humana is committed to diversity and inclusion, ensuring equal employment opportunities regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, disability, or veteran status.