Remote RN Care Manager: Compliance & Audit Specialist

IntePros; Pennsylvania; Remote; USD 85.000 - 110.000; Teilzeit

Zusammenfassung

A healthcare management firm is seeking an RN Care Management Coordinator – Compliance Specialist to ensure compliance with relevant regulations and standards. This remote position requires a minimum of five years of clinical experience, an active PA RN license, and strong interpersonal and communication skills. The role involves conducting compliance audits and supporting NCQA-related operations.

Qualifikationen

• Minimum of five (5) years of clinical experience.
• Active Pennsylvania Registered Nurse (RN) license required. BSN preferred.
• Strong interpersonal skills with the ability to provide constructive feedback.
• Solid knowledge of utilization review processes and management systems.
• Exceptional verbal and written communication skills.
• Demonstrated experience with NCQA, CMS, and other regulatory compliance programs.

Aufgaben

• Evaluate and interpret regulations and standards.
• Conduct monthly compliance audits and report findings.
• Perform ongoing sample case reviews to verify correct application of criteria.
• Ensure clinical staff documentation meets regulatory standards.
• Serve as a resource for internal teams and stakeholders.
• Support NCQA-related business operations.

Kenntnisse

Clinical experience

Interpersonal skills

Knowledge of utilization review

Communication skills

Proficiency in Microsoft Excel

Problem-solving skills

Ausbildung

Active Pennsylvania Registered Nurse (RN) license

BSN (Bachelor of Science in Nursing)

Tools

Microsoft Excel

Microsoft PowerPoint

Microsoft Word

Jobbeschreibung

A healthcare management firm is seeking an RN Care Management Coordinator – Compliance Specialist to ensure compliance with relevant regulations and standards. This remote position requires a minimum of five years of clinical experience, an active PA RN license, and strong interpersonal and communication skills. The role involves conducting compliance audits and supporting NCQA-related operations.