Clinical Compliance Specialist, RN – Remote

HealthCare Support is currently interviewing for a Remote RN - Clinical Compliance Specialist with a top-rated behavioral health organization dedicated to advancing mental health care for families and individuals. This Remote RN - Clinical Compliance Specialist is a permanent, full time position offering a competitive salary, full benefits and the luxury of working remote.

PERKS of this Remote RN - Clinical Compliance Specialist

Compensation:

• Starting at $85k/yr and up DOE along with up to 5% HEDIS Bonus

Benefits:

• Benefits are effective on the 1st of the month following the first 30 days of employment (Example: If they start December 13th, benefits kick-in on February 1st)
• Very low healthcare premiums ($35 - $100 depending on the plan!)
• 18 days of PTO 11 paid holiday 3 sick days = 32 days
• Fitness Reimbursement up to $125/a year and on-site fitness facility
• Tuition Reimbursement: Up to $3k below graduate level reimbursement and $5k for graduate level (eligible after 1 year)
• 457(b) Retirement Plan – company matches 3% of base salary
• CalPERS Retirement Plan (i.e., pension plan for all employees) – full vesting after 5 years
• NEW Wellness Benefit after 1 year of employment (they have the option to select 1 of 3) – student loan reimbursement, tuition reimbursement, or Lifestyle Spending Account (LSA)
• Annual Performance Review and Merit increase

Shift: Monday – Friday, 8 a.m. – 5 p.m.

DAILY JOB DUTIES of this Remote RN - Clinical Compliance Specialist opportunity:

1. Assists in the continual maintenance of policies/procedures, letter templates, workflows, process, audit tools and training materials in compliance with regulatory requirements, new legislation, and accreditation standards. Works collaboratively with Regulatory Affairs and Compliance Audit and Oversight to ensure business units are made aware and department documents updated accordingly.

2. Develops and maintains training materials in compliance with all regulatory requirements, new legislation, and accreditation standards.

3. Assists in the preparation of the business units for review by external regulatory and accrediting bodies (Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and Centers for Medicare and Medicaid Services (CMS), and internally for audits by Compliance.

4. Assists in the development and revisions of audit tools, policies, and provider trainings to improve compliance with regulatory and accreditation standards.

5. Provides training, education, and consultation as necessary to delegates. Collaborates with UM and Delegation Oversight on identifying topics and developing agendas for the JOMs/performance visits/communications.

6. Leads coordination and performance of pre-delegation and annual audits for delegates. The Clinical Compliance Specialist is responsible for: arranging for mailing of pre-audit letters/audit tools and reporting requirements; supporting staff on coordination of scheduling audits, maintaining annual audit schedules, and submitting corrective action plans; ensuring follow-up with mailings of letters and CAPs are completed within timeframes; administering monitoring of all post-audit delegated activities to ensure compliance with federal, state, and local requirements.

7. Attends and presents at the Executive Compliance Committee, Quality Improvement Committee, and others, as appropriate. Directs and creates memos and applicable charts and graphs for committee presentation.

8. Stays informed about the latest developments in delegated oversight field, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources.

9. Maintains confidentiality in compliance with all Health Insurance Portability and Accountability Act (HIPAA) requirements.

MINIMUM REQUIREMENTS of this Remote RN - Clinical Compliance Specialist opportunity:

• Associate degree in Nursing from an accredited institution
• Active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
• 5 years of experience in a clinical setting performing UM oversight, including auditing
• Must have one of the following certifications: Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Certified Professional in Healthcare Quality (CPHQ), OR Certified in Healthcare Compliance (CHC)
• Thorough knowledge and understanding of healthcare compliance and fraud, waste, and abuse principles and practices and Medicare and Medicaid regulations and guidelines.
• Working knowledge of licensure and regulatory requirements, and accreditation standards.
• Knowledge of issues pertaining to Medi-Cal, Medicare, and other HMO & IPA contracts & payers.

Interested in being Considered?

If you are interested in applying to this position, please click Apply Now for immediate consideration or email Adam Sanabria directly at asanabria@healthcaresupport.com.

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Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.