Internal Audit - Nurse Auditor

** Become a part of our caring community*
* The Internal Audit - Nurse Auditor (Quality Assurance Professional
2) serves as a clinical subject matter expert within Humana's Internal Audit, supporting audit projects and consulting engagements across Center Well, Care Management, Utilization Management, and other healthcare operations. You will work closely with audit professionals and business leaders and play a critical role in evaluating the efficiency and effectiveness of Humana's operational processes

The ideal candidate brings a strong clinical background and a passion for improving healthcare quality and outcomes through objective analysis and problem-solving. This unique role offers an opportunity to apply nursing expertise beyond direct patient care by executing audit plans, preparing reports for management on the results of risk audits, and providing recommendations on improvements.

+ Perform audit projects and consulting engagements following established methodology within budgeted time frames.

+ Serve as the clinical subject matter expert supporting Internal Center Well, Care Management, Utilization Management, and other healthcare delivery functions.

+ Partner with audit professionals to provide clinical insight during audit planning, testing, and reporting activities, helping evaluate the effectiveness of key processes, controls, and compliance with regulatory, contractual, and organizational requirements.

+ Reviews clinical documentation, operational workflows, and quality management activities to identify potential risks, evaluate the effectiveness of controls, and recommend process improvements that enhance compliance, quality, and operational performance.

+ Communicate the results of audit and consulting projects with written reports and oral presentations to management.

** Use your skills to make an impact*
* ** Required Qualifications*
* + An active, unrestricted, RN license.

+ Three (3) or more years of clinical nursing experience, with demonstrated knowledge of care management, utilization management, population health, or healthcare operations.

+ Experience evaluating clinical processes, internal controls, compliance programs, clinical documentation, healthcare operations, and workflow effectiveness to assess regulatory compliance, quality outcomes, and operational performance.

+ Knowledge of healthcare regulations, accreditation standards, and industry best practices, including CMS, NCQA, URAC or state and federal requirements.

+ Proficient in Microsoft Office Suite, including Word, Excel, and PowerPoint with the ability to support operational and audit activities.

+ Strong written and oral communication skills, with the ability to prepare clear, concise reports and collaborate effectively with stakeholders at all levels of the organization.

** Preferred Qualifications*
* + Case Management (CCM), Utilization Management (CPUM), Internal Auditing (CIA), or related discipline.

+ Experience in managed care or health care administration.

+ Experience participating in audits, assessments, quality reviews, or compliance monitoring activities within care management, utilization management, or healthcare operations.

** Additional Information*
* +  
** Workstyle:
** This is a remote position.

+  
** Travel:
** Up to 5% travel is required for team engagement meetings, which may occur outside your state of residence.

+  
** Typical Workdays and

Hours:

** Monday - Friday; 8:00AM - 5:00 PM Eastern Time (ET).

Work at Home 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 criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

** Scheduled Weekly Hours*
* 40

** Pay Range*
* The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and…