Clinical Compliance Manager

2 weeks ago

Dallas, Texas, United States Signify Health Full time
Job Overview

Impact of the Role:

In this position, you will bring clinical knowledge, guidance, and organization to a newly established clinical compliance team. This team is dedicated to ensuring that our members receive optimal care while overseeing the policies and procedures associated with clinical compliance. You will take charge of all clinical compliance evaluations, including the investigation of member grievances concerning potential compliance matters. Additionally, you will serve as the company authority on clinical compliance issues, regulations, and vulnerabilities. This prominent role will collaborate closely with the enterprise compliance team, legal department, and senior management.


Key Responsibilities:

  • Lead the internal clinical compliance operations team
  • Ensure that processes and structures enable Signify to deliver the highest quality and compliance to our clients
  • Engage with internal and external stakeholders, including clients, providers, and members
  • Utilize clinical judgment to advise leadership on clinical compliance investigations, amendments, and proactive compliance matters
  • Analyze trends and collaborate with senior management to implement necessary improvements
  • Act as the primary owner of the member amendment process
  • Serve as a subject matter expert (SME) on compliance-related dashboards and research
  • Disseminate information regarding regulatory issues
  • Perform other duties as assigned

Qualifications:

  • Bachelor of Science in Nursing (BSN) and a valid Registered Nurse (RN) license (minimum requirement)
  • At least 1 year of leadership experience
  • 5-10 years of experience in a clinical healthcare environment, with a focus on quality and compliance preferred
  • Familiarity with medical coding and CMS guidelines
  • Comprehensive understanding of medical terminology
  • Previous experience in provider communication
  • Strong verbal and written communication abilities
  • Self-motivated with a proactive approach to learning new programs, policies, and skills
  • Independent and self-directed, capable of managing daily objectives
  • Ability to thrive in a fast-paced environment with shifting priorities, maintaining flexibility and a positive demeanor

Desired Attributes:

  • Commitment to ethical conduct
  • Self-motivation and initiative in acquiring new knowledge and skills
  • Ability to work independently and manage daily responsibilities

Compensation:

The salary range for this position is $74,700 to $130,200. The offered compensation will be influenced by factors such as location, level, job-related knowledge, skills, and experience. Certain roles may qualify for incentive compensation, equity, and benefits.


Benefits:

In addition to your salary, you will enjoy the benefits of working for an organization that values caring for its employees and communities. Eligible employees can enroll in a comprehensive range of medical, dental, and vision benefits, a 401(k) retirement savings plan, and an Employee Stock Purchase Plan. Additional offerings include education assistance, free development courses, paid time off programs, paid holidays, and discounts at CVS stores and with participating partners.


About Signify Health:

Signify Health is dedicated to creating the healthcare system we all aspire to experience by transforming homes into healthcare hubs. We provide holistic care coordination that addresses individuals' clinical, social, and behavioral needs, allowing them to enjoy healthier days at home. By fostering strong connections with primary care providers and community resources, we effectively close critical care and social gaps while managing risk for those in greatest need. This approach leads to improved outcomes and enhanced experiences for all involved.


Our high-performance networks are supported by over 9,000 mobile doctors and nurses across the U.S., 3,500 healthcare providers and facilities engaged in value-based arrangements, and numerous community-based organizations. Signify's intelligent technology and decision-support services streamline care coordination for more than 1.5 million individuals annually, assisting payers and providers in implementing effective value-based care programs.


Diversity and Inclusion are fundamental values at Signify Health, and fostering a workplace culture that reflects these values is essential to our ongoing success as an organization. We are committed to equal employment opportunities for all employees and job applicants, ensuring an environment where individuals are valued for their unique differences.

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