Utilization Management Compliance Registered Nurse, RN

At Humana, we believe in providing quality healthcare services that meet the needs of our diverse and growing population. As a Utilization Management Compliance Registered Nurse, RN, you will play a critical role in ensuring that our organization maintains compliance with all regulatory and accreditation standards related to utilization management. This is a dynamic and challenging position that requires a detail-oriented and highly motivated individual with a strong understanding of healthcare regulations and a passion for promoting quality care. If you are a dedicated and experienced RN with a commitment to compliance and a desire to make a positive impact on the healthcare industry, we encourage you to apply for this exciting opportunity.

1. Ensure compliance with all regulatory and accreditation standards related to utilization management.
2. Develop and implement policies and procedures to maintain compliance with healthcare regulations.
3. Conduct audits and reviews to identify any potential compliance issues and recommend corrective actions.
4. Monitor utilization management processes and practices to ensure adherence to regulations.
5. Collaborate with cross-functional teams to identify and implement best practices for compliance.
6. Provide training and education to staff on compliance-related topics.
7. Stay up-to-date on changes in healthcare regulations and incorporate them into compliance processes.
8. Develop and maintain relationships with regulatory agencies and accreditation bodies.
9. Conduct internal reviews and investigations to ensure compliance with company policies and procedures.
10. Work closely with the legal team to address compliance issues and mitigate potential risks.
11. Participate in external audits and surveys to ensure compliance with regulatory and accreditation standards.
12. Serve as a subject matter expert and resource on compliance-related matters.
13. Analyze data and metrics to identify trends and areas for improvement in compliance.
14. Communicate compliance updates and changes to relevant stakeholders.
15. Maintain accurate and thorough documentation of compliance efforts and activities.
16. Collaborate with other departments to develop and implement quality improvement initiatives.
17. Demonstrate a commitment to promoting quality care and patient safety.
18. Adhere to ethical and professional standards in all interactions and decisions.
19. Continuously evaluate and improve compliance processes and procedures.
20. Proactively identify and address potential compliance risks and issues.

According to JobzMall, the average salary range for a Utilization Management Compliance Registered Nurse, RN in Atlanta, GA, USA is between $72,000 and $93,000 per year. This salary range can vary depending on factors such as experience, education, and employer. Some employers may also offer additional benefits and bonuses.

Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.