Humana RN Quality Audit Clinical Advisor in San Juan, Puerto Rico

Role:RN Quality Audit Clinical Advisor -Bilingual (Spanish / English)

Assignment:Health Risk Assessment

Location: Puerto Rico

Assignment Capsule

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

Role Essentials

  • 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.

    Role Desirables

  • 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

    Humana Perks:

  • 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.