Internal Audit – Nurse Auditor

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The Internal Audit - Nurse Auditor (Quality Assurance Professional 2) serves as a clinical subject matter expert within Humana's Internal Audit, supporting audit projects and consulting engagements across CenterWell, Care Management, Utilization Management, and other healthcare operations. You will work closely with audit professionals and business leaders and play a critical role in evaluating the efficiency and effectiveness of Humana's operational processes

The ideal candidate brings a strong clinical background and a passion for improving healthcare quality and outcomes through objective analysis and problem-solving. This unique role offers an opportunity to apply nursing expertise beyond direct patient care by executing audit plans, preparing reports for management on the results of risk audits, and providing recommendations on improvements.

• Perform audit projects and consulting engagements following established methodology within budgeted timeframes.
• Serve as the clinical subject matter expert supporting Internal CenterWell, Care Management, Utilization Management, and other healthcare delivery functions.
• Partner with audit professionals to provide clinical insight during audit planning, testing, and reporting activities, helping evaluate the effectiveness of key processes, controls, and compliance with regulatory, contractual, and organizational requirements.
• Reviews clinical documentation, operational workflows, and quality management activities to identify potential risks, evaluate the effectiveness of controls, and recommend process improvements that enhance compliance, quality, and operational performance.
• Communicate the results of audit and consulting projects with written reports and oral presentations to management.

Use your skills to make an impact

Required Qualifications

• An active, unrestricted, RN license.
• Three (3) or more years of clinical nursing experience, with demonstrated knowledge of care management, utilization management, population health, or healthcare operations.
• Experience evaluating clinical processes, internal controls, compliance programs, clinical documentation, healthcare operations, and workflow effectiveness to assess regulatory compliance, quality outcomes, and operational performance.
• Knowledge of healthcare regulations, accreditation standards, and industry best practices, including CMS, NCQA, URAC or state and federal requirements.
• Proficient in Microsoft Office Suite, including Word, Excel, and PowerPoint with the ability to support operational and audit activities.
• Strong written and oral communication skills, with the ability to prepare clear, concise reports and collaborate effectively with stakeholders at all levels of the organization.

Preferred Qualifications

• Case Management (CCM), Utilization Management (CPUM), Internal Auditing (CIA), or related discipline.
• Experience in managed care or health care administration.
• Experience participating in audits, assessments, quality reviews, or compliance monitoring activities within care management, utilization management, or healthcare operations.

Additional Information

• Workstyle: This is a remote position.
• Travel: Up to 5% travel is required for team engagement meetings, which may occur outside your state of residence.
• Typical Workdays and Hours: Monday - Friday; 8:00AM - 5:00 PM Eastern Time (ET).

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.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.$65,000 - $88,600 per yearThis 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 12-15-2026

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 at Humana.com and at CenterWell.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.