KY Medicaid Behavioral Health Utilization Mgnt. Compliance Nurse

Profile

Description

The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Compliance Nurse 2 ensures mandatory reporting completed. Conducts and summarizes compliance audits.


Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals.
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.


Required Qualifications


Bachelor's degree or equivalent experience
Active Unrestricted RN license in the state(s) in which the nurse is required to practice
Ability to be licensed in multiple states without restrictions
A minimum of three years psychiatric/behavioral health nursing experience
A minimum of three years in Utilization Management (Managed Care or Provider)
Proficient with Microsoft Office products including Word, Excel and Outlook
Ability to work independently under general instructions and with a team
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Must be available to work Monday - Friday 8:30-5:00 PM


Additional Requirements


Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required


Preferred Qualifications


BSN
Previous Medicaid experience a plus
Previous experience in compliance, case management, and/or discharge planning
Certification in Case Management a plus (CCM)
Experience in auditing, training or performance improvement is preferred


Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

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