Columbia, SC · On-site +1
Current RN or MSW license in state of employment * 2 or more years of Medicaid Experience ... While this is a remote position, occasional travel to Humana's offices for training or meetings may ...
Columbia, SC · On-site +1
Current RN or MSW license in state of employment * 2 or more years of Medicaid Experience ... While this is a remote position, occasional travel to Humana's offices for training or meetings may ...
Columbia, SC · On-site +1
Current RN or MSW license in state of employment * 2 or more years of Medicaid Experience ... While this is a remote position, occasional travel to Humana's offices for training or meetings may ...
Columbia, SC · On-site +1
Current RN or MSW license in state of employment * 2 or more years of Medicaid Experience ... While this is a remote position, occasional travel to Humana's offices for training or meetings may ...
$18.24 - $20.50
6% of jobs
$20.50 - $22.76
6% of jobs
$22.76 - $25.03
3% of jobs
$26.48 is the 25th percentile. Wages below this are outliers.
$25.03 - $27.29
15% of jobs
$27.29 - $29.56
17% of jobs
The median wage is $29.87 / hr.
$29.56 - $31.82
23% of jobs
$32.63 is the 75th percentile. Wages above this are outliers.
$31.82 - $34.09
15% of jobs
$34.09 - $36.35
8% of jobs
$36.35 - $38.62
0% of jobs
$38.62 - $40.88
0% of jobs
$40.88 - $43.14
7% of jobs
$18
$30
$43
| Aspect | Remote Rn Auditor | Remote Rn Reviewer |
|---|---|---|
| Certifications | RN license, auditing certifications (e.g., CHAP, RAC) | RN license, clinical review certifications |
| Work Environment | Healthcare organizations, insurance companies, auditing firms | Healthcare providers, insurance companies, utilization review |
| Primary Responsibilities | Auditing medical records for compliance, coding accuracy, and billing | Reviewing medical records for appropriateness and medical necessity |
Remote Rn Auditors focus on compliance and coding accuracy through audits, while Remote Rn Reviewers primarily assess medical necessity and appropriateness of care. Both roles require RN licensure and related certifications, often working within healthcare or insurance settings. The key difference lies in their core functions: auditing versus clinical review, though both contribute to quality and compliance in healthcare reimbursement.
As a remote RN auditor, your job is to review claims and audit financial statements to ensure validity and accuracy. In this role, you may examine documentation from the patient or clinic, evaluate the effectiveness of care, or ensure that claims comply with government regulations. RN auditors often provide advice for cutting costs and contact both healthcare providers and clients to negotiate specific claims or resolve billing issues. Remote RN auditors often work with daily or weekly batches of work as assigned, but in rare cases, you may be asked to prioritize auditing certain material when time is of the essence.
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 6 days ago
8.0
Based on 254 frontline employees who took The Breakroom Quiz
147th of 261 rated insurance
The Process Improvement Lead researches best business practices within and outside the organization to establish benchmarks for the team. You will review processes, streamline the department, ensuring better collaboration, efficiency and compliance. You will develop new process and practices for the team. Be a point person for the department regarding resources and procedures in areas such as compliance, audits, quality reviews like NCQA. You will also collect and analyze data, identifying gaps and building out process to develop best practices. You will review job aids, be the point person in the new hire onboarding and training processes of the department to ensure the team follows best in class business practices and procedures that focus on enhanced safety, increased productivity and reduced cost. You may advise leadership to develop functional strategies (often segment specific) on matters of significance.
Required Qualifications
Bachelor's degree
5 or more years of process improvement experience
2 or more years of project leadership experience
Must have 2 or more years of experience in case management and/or utilization management experience
Preferred Qualifications
Current RN or MSW license in state of employment
2 or more years of Medicaid Experience
Certification in Lean, Six Sigma, or similar process improvement methodology is preferred.
Ability to manage multiple initiatives and facilitate change in a matrixed organization.
Familiarity with Project Management tools and resources
Additional Information
Work-At-Home Requirements:
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
Interview Format:
As part of our hiring process for this opportunity, we will be using exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first-round interview, you will receive an email correspondence inviting you to participate in a HireVue interview. In this interview, you will receive a set of interview questions you may answer via by phone or computer, and you will provide recorded or text message responses to each question. Some of the questions may require longer responses and using a computer vs phone to type responses may work best. You should anticipate this interview to take about 15-20 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Why Humana?
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
Health benefits effective day 1
Paid time off, holidays, volunteer time and jury duty pay
Recognition pay
401(k) retirement savings plan with employer match
Tuition assistance
Scholarships for eligible dependents
Parental and caregiver leave
Employee charity matching program
Network Resource Groups (NRGs)
Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay 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.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.
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.
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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.
Health care and social assistance
10,000+ Employees
Louisville, KY, US
1961
