RN Compliance Specialist

1 week ago

Philadelphia, United States IntePros Full time
Compensation Range:

$40.00 per hour

Welcome to IntePros, a certified woman-owned company specializing in innovative and results-oriented recruiting and staffing solutions. We take immense pride in genuinely understanding what drives and inspires exceptional individuals like you. Your success is our priority, and we are dedicated to actively shaping your long-term career journey. At IntePros, we believe in comprehensive well-being. You have access to our medical, dental, vision, and mental health programs, ensuring your health and wellness are taken care of. To support your continuous growth, we also provide a $1,500 per year education and professional certification fund. Diversity and inclusion are cornerstones of our company ethos. IntePros is proud to be an equal opportunity employer. We do not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, sexual orientation, disability, age, veteran or military status, retaliation, or any other characteristic protected by law. We celebrate the rich tapestry of backgrounds and perspectives that make us stronger as a team. Please note that only qualified individuals being considered will be contacted. We appreciate your interest and look forward to potentially embarking on a transformative journey together.

Job Title: RN Compliance Specialist

Intepros is seeking a dedicated RN Compliance Specialist for one of our healthcare clients. This is a remote position, but candidates must reside in the tri-state area and hold an active PA/NJ license. LPNs with compliance experience will also be considered.

Responsibilities:

  • Regulation Assessment and Implementation: Assess NCQA, CMS, and state regulations and standards to ensure appropriate controls are in place. Make recommendations and oversee the implementation of new controls as necessary.
  • Case Review: Conduct ongoing sample case reviews to ensure staff correctly apply InterQual and medical/departmental policy guidelines, and refer appropriate cases to the Medical Director. Ensure information provided to the Medical Director is relevant and helpful in making determinations.
  • Documentation Assurance: Ensure clinical staff document appropriately in the medical management system so that member letters are clear, understandable, and meet regulatory requirements.

Qualifications:

  • Licensure: Active PA or NJ Licensed Registered Nurse required.
  • Education: BSN preferred.
  • Utilization Review: Knowledge of utilization review processes and utilization management systems. Moderate to strong knowledge of InterQual required.
  • Regulatory Compliance: Experience adhering to NCQA, CMS, and other programs requiring regulatory compliance.

Join our team and help us maintain the highest standards of regulatory compliance and quality in healthcare. Apply today to make a meaningful impact

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