Clinical Quality & Regulatory Compliance Specialist

PacificSource; Boise (ID); Sur place; USD 90 000 - 120 000; Plein temps

Résumé du poste

PacificSource is seeking an experienced Health Services Compliance professional to monitor and report on operational activities, audits, and regulatory requirements. You will collaborate with Health Services leadership and Compliance to oversee delegated functions and ensure adherence to federal, state, and contract standards.

The role emphasizes continuous improvement using LEAN methodologies, conducting routine audits, and training staff to ensure HIPAA compliance and regulatory alignment

Responsabilités

• Develop and conduct internal audits to assess compliance with federal, state, organizational, and industry rules and standards.
• Monitor health services operations to ensure compliance with rules and standards; report findings to leadership and committees.
• Oversee delegation of vendors to ensure delegated functions meet service agreement requirements and regulations.
• Perform at least monthly monitoring of staff and subcontractors involved in utilization management to ensure policy adherence.
• Serve as liaison between Health Services, Compliance, and FWA teams for detecting and reporting issues.
• Maintain knowledge of state contract language and federal/state requirements; provide interpretation and training on new rules.
• Respond to inquiries from internal and external auditors in a timely and accurate manner to minimize impact.
• Prepare and submit required reporting to federal/state agencies and organizational committees.
• Participate in meetings and audits; apply LEAN and quality improvement principles to monitor KPIs and drive actions.
• Contribute to employee education programs addressing regulatory requirements and onboarding.

Description du poste

PacificSource is seeking an experienced Health Services Compliance professional to monitor and report on operational activities, audits, and regulatory requirements. You will collaborate with Health Services leadership and Compliance to oversee delegated functions and ensure adherence to federal, state, and contract standards.

The role emphasizes continuous improvement using LEAN methodologies, conducting routine audits, and training staff to ensure HIPAA compliance and regulatory alignment