Compliance Registered Nurse

Humana Inc.

Job Overview

Location

Remote Virginia

Job Type

Full-time

Full Job Description

📋 Description

• The Compliance Registered Nurse role at Humana Inc. is critical to ensuring adherence to healthcare regulations, preventing fraud, waste, and abuse, and supporting quality care delivery through rigorous auditing and case management oversight.
• Day-to-day responsibilities include reviewing case management and utilization management activities, conducting compliance audits, analyzing clinical data, ensuring adherence to DMAS, NCQA, CMS, and Humana policies, and preparing reports on deficiencies and risks.
• The role operates within Humana’s compliance and quality teams, supporting organizational strategy by linking auditing outcomes to operational improvements and regulatory adherence across Medicaid and Medicare lines of business.
• The incumbent will develop advanced skills in healthcare compliance, data analysis, regulatory interpretation, and independent decision-making while contributing to fraud prevention and quality improvement initiatives.

🎯 Requirements

• Active Registered Nurse license in Virginia or eligibility for multi-state licensure via eNLC from a bordering state (TN, WV, NC, MD, KY) without disciplinary action
• Minimum two years of auditing experience in a clinical or Managed Care Organization (MCO) setting
• Intermediate to advanced proficiency in Microsoft Office (Word, Excel, PowerPoint) and ability to navigate multiple systems and troubleshoot technical issues in a remote environment

🏖️ Benefits

• Competitive annual salary range of $71,100 to $97,800, plus eligibility for performance-based bonus incentives
• Comprehensive benefits package including medical, dental, vision, 401(k) retirement savings, paid time off, parental leave, and disability coverage
• Fully remote work arrangement with required home office setup support, including telecommunications equipment and internet speed guidelines (25 Mbps download, 10 Mbps upload)

Skills & Technologies

Remote

$71k-97k

Degree Required

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Humana Inc.

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About Humana Inc.

Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.

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