Health Services Compliance & Quality Lead

PacificSource; Portland (OR); Sur place; USD 71 000 - 106 000; Plein temps

Résumé du poste

PacificSource in Oregon is seeking a Health Services Compliance Specialist to support audits, monitor regulatory requirements, and ensure adherence to federal, state, and contractual standards. You will work with Leadership and Compliance to oversee delegated functions and respond to inquiries.

The role emphasizes collaboration, documentation, and training; you will help develop policies, maintain audit trails, and prepare required reports, while applying LEAN methods to improve performance and

Qualifications

• RN license and active state licensure.
• Experience in health services compliance and audits.
• Knowledge of ICD-10, DSM-IV, CPT codes.
• Strong analytical and communication skills.

Responsabilités

• Develop and conduct internal audits to ensure regulatory compliance.
• Monitor health services operations for adherence to rules.
• Oversee vendor delegation to ensure contract compliance.
• Monthly monitoring of staff and vendors in utilization management decisions.
• Serve as liaison with FWA teams for identifying investigations.
• Respond to inquiries from federal/state regulators and audits.

Connaissances

Accountability

Collaboration

Communication

Flexibility

Listening

Organizational skills

Problem Solving

Teamwork

Formation

RN license

Licensed Clinical Psychologist

Licensed Clinical Social Worker

CCR/CCM certification

Description du poste

PacificSource in Oregon is seeking a Health Services Compliance Specialist to support audits, monitor regulatory requirements, and ensure adherence to federal, state, and contractual standards. You will work with Leadership and Compliance to oversee delegated functions and respond to inquiries.

The role emphasizes collaboration, documentation, and training; you will help develop policies, maintain audit trails, and prepare required reports, while applying LEAN methods to improve performance and