Clinical Quality & Regulatory Compliance Lead

PacificSource; Bend (OR); On-site; USD 71,000 - 106,000; Full time

Job summary

PacificSource is seeking an experienced Health Services Compliance professional to support audits, reporting, and education across regulatory requirements. The role emphasizes collaboration with leadership,Compliance, and FWA teams to uphold standards and improve processes.

The position requires nursing or behavioral health credentials with extensive compliance and auditing experience. It includes preparation of quarterly reports and ongoing staff education on regulatory updates, with travel as

Qualifications

• Six years nursing or clinical behavioral health experience required.
• Two years in insurance industry experience preferred.
• Knowledge of ICD-10, DSM-IV, CPT codes and health benefits.
• Ability to interpret regulations and train staff.

Responsibilities

• Collaborate to conduct internal audits for compliance with rules and standards.
• Monitor health services operations and report findings to leadership.
• Oversee vendor delegation and ensure contract adherence.
• Monitor utilization management and clinical policy adherence monthly.
• Serve as liaison with FWA teams for reporting and investigation.
• Stay current on state/federal contract language and regulations.
• Respond to inquiries from auditors with timely, professional communication.
• Prepare and present required external reports to agencies and committees.
• Participate in meetings, committees, and audits as needed.
• Apply LEAN methods and KPI visual boards to drive improvements.
• Review and update policies, procedures, and onboarding materials.
• Support employee education programs on regulatory requirements.

Skills

Nursing experience

Clinical behavioral health

Regulatory knowledge

Auditing experience

Policy interpretation

Training and education

Communication

LEAN quality improvement

Education

Registered Nurse license

Behavioral health credentials

CCM certification (preferred)

Tools

HIPAA compliance tools

Job description

PacificSource is seeking an experienced Health Services Compliance professional to support audits, reporting, and education across regulatory requirements. The role emphasizes collaboration with leadership,Compliance, and FWA teams to uphold standards and improve processes.

The position requires nursing or behavioral health credentials with extensive compliance and auditing experience. It includes preparation of quarterly reports and ongoing staff education on regulatory updates, with travel as