Clinical Quality & Regulatory Compliance Lead

PacificSource; Georgia; Hybrid; USD 71,000 - 106,000; Full time

Job summary

PacificSource in Georgia is seeking an experienced Health Services Compliance Auditor to monitor and report on operations, audits, and delegated functions. You will ensure adherence to federal/state rules, assist with education programs, and collaborate across Compliance, leadership, and external auditors.

Minimum six years in nursing or behavioral health, with relevant licensure and knowledge of HIPAA, CMS/OMBP requirements.

Qualifications

• Six years nursing or clinical behavioral health experience required.
• Current, unrestricted state license(s) in nursing or behavioral health.
• Familiarity with health services regulations, audits, and contractual terms.

Responsibilities

• Collaborate with leadership to develop and conduct internal audits.
• Monitor operations for compliance with federal, state, and internal rules.
• Oversee vendor delegation and ensure service performance compliance.
• Monthly monitoring of staff and vendors involved in utilization management.
• Coordinate with FWA teams to identify and report issues.
• Provide interpretation and training on new regulatory requirements.
• Prepare reporting to federal/state agencies and internal committees.
• Participate in internal/external meetings and audits as needed.
• Apply LEAN and quality improvement to monitor KPIs and drive improvements.
• Assist with creating/update of compliant policies and onboarding materials.

Skills

Audit skills

Regulatory knowledge

Communication

Collaboration

Problem solving

Documentation

Education

Nursing license and/or behavioral health licensure

Tools

EHR systems

Compliance software

Job description

PacificSource in Georgia is seeking an experienced Health Services Compliance Auditor to monitor and report on operations, audits, and delegated functions. You will ensure adherence to federal/state rules, assist with education programs, and collaborate across Compliance, leadership, and external auditors.

Minimum six years in nursing or behavioral health, with relevant licensure and knowledge of HIPAA, CMS/OMBP requirements.