Remote Rn Auditor Jobs in Brookfield, WI (NOW HIRING)

Become a part of our caring community
Make a meaningful impact on the lives of Wisconsin Medicaid members by joining Humana as a Care Management Telephonic Nurse. You will be part of a collaborative, interdisciplinary team dedicated to supporting individuals with complex medical, behavioral health, and social needs. You'll work closely with providers, behavioral health specialists, and community organizations to deliver coordinated, high-quality care that truly makes a difference.
Through comprehensive assessments, personalized care planning, and ongoing support, you'll help ensure members receive the right care at the right time-all while promoting efficient, cost-effective solutions. You'll report directly to the Manager of Care Management and help improve health outcomes across the communities you serve.

• Assist Care Managers in the oversight, development, and prioritization of member care plans addressing complex medical, behavioral health, and social needs.
• Monitor member status and direct members to appropriate specialty services, community resources, and alternative treatment settings.
• Participate in coordinating member discharge needs in collaboration with facility discharge planners, Care Coordinators, Care Managers, and behavioral health personnel, and assists with medical transitions of care.
• Coordinate services, communicate clinical information, and interface with health care providers regarding the management of current medical, behavioral health, and social needs.
• Support the high risk and complex case management team with completing comprehensive assessments and managing members
• Educate on chronic conditions and preventive health measures
• Problemsolve with staff, members, and providers to identify appropriate alternatives or solutions to care needs.
• Participate in interdisciplinary team meetings as a member or facilitator.
• Serve as a clinical resource to iCare staff and assist with training and mentoring of employees.
• Support program development and procedure enhancements, and provide input to Quality Improvement and Quality Assurance programs.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree.
• Licensed Registered Nurse (RN) in the State of Wisconsin, with no disciplinary action.
• Two (2) years of healthcare experience as an RN.

Preferred Qualifications

• Bilingual in English/Spanish.
• Experience with case management, discharge planning and patient education for adult acute care.
• Managed care experience.
• Certified Case Manager (CCM).

Additional Information

• Location: must reside in WI
• Workstyle: Remote, work from home.
• Schedule: Monday - Friday, 8:30 am - 5:00 pm CST

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees', 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 required; 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 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 use an interviewing technology called HireVue to enhance our hiring. HireVue allows us to quickly connect and gain valuable information from you about your relevant experience at a time that is best for your schedule.

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 location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.