Role:RN Quality Audit Clinical Advisor -Bilingual (Spanish / English)
Assignment:Health Risk Assessment
Location: Puerto Rico
As an RN Quality Audit Clinical Advisor you will be responsible for the following:
Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols
Review case management protocols to ensure compliance with CMS requirements
Conduct internal regulatory compliance audits to determine process accuracy
Report audit results and provide recommendations to market leaders and stateside regulatory compliance area
Must have an active RN Puerto Rico License
Bachelor’s degree in Nursing.
Member of CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico).
Must apply and achieve FL RN license within 30-45 days of employment or must successfully complete and pass the NCLEX exam within 30-45 days.
This position is full-time Monday – Friday from 8am-6pm. It may be necessary, given the business need, to work on the weekends.
Health Plan experience
Bilingual English/Spanish desired
Previous Case Management Experience
Previous experience in audits
Call center or triage experience
Previous experience managing Medicare members
Full time associates enjoy competitive pay and a comprehensive benefits package that includes:
Two types of Medical plans with pharmacy coverage
Dental, Vision & Life Insurance offered
401 k Retirement Savings Plan offered after 45 days of employment.
Spouse / partner coverage
Paid time off & Paid Holidays
Well-being programs where you can earn additional money, gift cards, or prizes for healthy behavior and wellness activities.
Volunteer Day Off
Education reimbursement and/or scholarships for qualifying dependent children
Parental leave include maternity, paternity and child adoption leave
Title: RN Quality Audit Clinical Advisor
Location: Puerto Rico-San Juan
Requisition ID: 181662
Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.