Nurse Audit Manager

About the Role

Become a part of our caring community and help us put health first. Step into a leadership role with Humana where your clinical expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager, you will spearhead audit and validation processes to ensure medical documentation and coding are precise, compliant, and support optimal reimbursement. This is an exciting opportunity to apply your advanced technical skills, shape best practices, and guide your team in solving complex challenges. You’ll work collaboratively across departments, lead initiatives, and play a key role in enhancing both operational efficiency and patient outcomes. Join us and be a driving force in upholding the highest standards of clinical integrity within a supportive, mission-driven organization.

Responsibilities

• Validates and interprets medical documentation to ensure capture of all relevant coding.
• Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management.
• Applies clinical and coding experience to conduct reviews of provider codes and billing.
• Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
• Requires cross departmental collaboration and conducts briefings and area meetings.
• Maintains frequent contact with other managers across the department.

Required Qualifications

• Registered nurse (RN).
• 5 or more years of clinical RN experience in a hospital setting.
• 3 or more years of experience providing leadership in a professional setting, such as managing teams, coordinating projects or initiatives, or serving as a subject matter expert.
• Comprehensive knowledge of Microsoft Office, Word, Excel and PowerPoint.
• Ability to work Eastern Standard Time zone hours.

Preferred Qualifications

• Bachelor’s degree in nursing, health admin, business or related field.
• Healthcare insurance industry knowledge.
• Experience validating and interpreting medical record documentation to ensure billing for services is complete and accurate.
• Certified Professional Coder or coding knowledge.
• Claims knowledge and understanding of claims processing.

Additional Information

• Employment Type: Full time
• Workstyle: Remote, work from home.
• Typical Work days/hours: Monday – Friday, 8:00am – 5:00pm EST.
• Direct Reports: Approximately 7 on-shore, 22 off-shore associates.
• Nationwide Remote: This is a remote nationwide position.
• 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

WAH Internet 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 recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.