Nurse Audit Manager

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

Step into a leadership role with Humana where your clinical expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager, you will spearhead audit and validation processes to ensure medical documentation and coding are precise, compliant, and support optimal reimbursement. This is an exciting opportunity to apply your advanced technical skills, shape best practices, and guide your team in solving complex challenges. You’ll work collaboratively across departments, lead initiatives, and play a key role in enhancing both operational efficiency and patient outcomes. Join us and be a driving force in upholding the highest standards of clinical integrity within a supportive, mission-driven organization. Additional Information Workstyle: Remote, work from home. Typical Work days/hours: Monday – Friday, 8:00am – 5:00pm EST. Direct Reports: approximately 7 on-shore, 22 off-shore associates.

Validates and interprets medical documentation to ensure capture of all relevant coding. Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. Applies clinical and coding experience to conduct reviews of provider codes and billing. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration and conducts briefings and area meetings. Maintains frequent contact with other managers across the department.