RN Clinical Compliance Specialist

Spectrum Health; Grand Rapids (MI); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Benefits package

On-demand pay

Discounts directory

Identity protection

Retirement options

Job summary

Corewell Health is seeking a Compliance professional to manage audits, investigations, and regulatory readiness within the clinical environment. You will work with legal counsel and operations to ensure adherence to applicable laws and standards while supporting the development and maintenance of policies and procedures.

The role emphasizes collaboration across departments, ongoing risk assessment, and education to promote compliance and high-quality care.

Qualifications

• Bachelor's Degree or equivalent in business, health care operations, nursing or related area.
• LIC-Registered Nurse (RN) State of Michigan.
• 2 years of related experience.
• Clinical Background Preferred.
• CRT-Healthcare Compliance, Certified (CHC) - HCCA Health Care Compliance Association.

Responsibilities

• Supports audits and investigations of compliance concerns related to the clinical environment; performs necessary research, documents findings, and follows up with applicable parties through complete resolution.
• Collects, collates, monitors and audits data and activities in the clinical environment to assure accuracy and to prevent, detect and correct non-compliance, illegal activities, and potential or actual fraud, waste or abuse.
• Supports regulatory surveyor site visits including preparation and corrective action response.
• Collaborates with operational areas and leadership through formal and informal means to implement ongoing risk identification and mitigation measures.
• Maintains knowledge of laws, regulations and standards impacting healthcare delivery and reimbursement.

Education

Bachelor's Degree or equivalent in business, health care operations, nursing or related area

CHC - Healthcare Compliance Certification

Job description

About Corewell Health

Our new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value. Through compassion, collaboration, clarity, curiosity and courage, we make anything and everything possible. Through our people, we care for the whole person with respect, dignity and love. Everyone deserves opportunities and resources for better health. Everyone deserves our relentless pursuit to innovate and always do better. Everyone deserves to have a community be a great place to live, work, learn and play. We believe health and well-being should be within reach for all. We believe the system to support the entire health and wellness journey starts with prevention. We believe that together we will make a difference. Together, we are here to make health better for everyone. Together, we are Corewell Health.

Scope of Work

• Assists with management of compliance and/or accreditation standards, laws, rules and regulations related to the clinical environment.
• Supports the resolution of compliance and/or accreditation investigations in the clinical environment and follows up with various parties to assure complete resolution.
• Supports the management and administration of the Compliance and/or Accreditation Plan(s).
• Identifies root causes and assures plans and standards are in place including development, education and implementation of related procedures and policies in the clinical environment.
• Maintains thorough knowledge of compliance and/or accreditation policies, procedures, issues, and trends.

Essential Functions

• Supports audits and investigations of compliance and/or accreditation concerns related to the clinical environment; performs necessary research, documents findings, and follows up with applicable parties through complete resolution.
• Collects, collates, monitors and audits data and activities in the clinical environment to assure accuracy and to prevent, detect and correct non-compliance, illegal activities, and potential or actual fraud, waste or abuse.
• Supports regulatory surveyor site visits including preparation and corrective action response.
• From time to time, performs investigations at the direction of legal counsel and works with legal counsel in the course of such investigation to provide guidance, recommendations and other assistance as requested by legal counsel.
• In such cases, the employee will report directly to legal counsel as opposed to employee’s up-line leadership, and such work with legal counsel shall be confidential and protected from disclosure by the attorney client privilege and work product protection.
• Exercises administrative judgment and assumes responsibility for decisions, consequences and results having an impact on people, costs, and quality of service.
• Assists with the development, implementation and maintenance of process improvement including departmental and/or organizational policies, procedures and methodologies and medical record design - assuring compliance with laws, regulations and standards while using accumulated data.
• Reviews and monitors adherence to documented plans and programs including the Code of Excellence.
• Assists in the review of clinical regulatory standards, evaluation of the level of compliance, identification of challenges, proposal of solutions, monitoring of compliance and management of evidence documents.
• Assists with continuous readiness activities.
• Collaborates with operational and other areas in investigations and to implement ongoing risk identification and mitigation measures related to the clinical environment.
• Proactively consults with operational areas and leadership through both formal (meetings, education) and informal means.
• Maintains knowledge of laws, regulations and standards impacting healthcare delivery and reimbursement.
• Applies laws, regulations and standards in daily situations while educating others through various means including formal training and education.
• Performs or supports related assessments to assure compliance to laws, regulations, standards and policies and procedures.
• Assists in a variety of projects related to compliance and accreditation related to the clinical environment.
• Identifies best practices and research and evaluates its implementation within our organization.
• Assists in the development of recommendations and action plans.
• Maintains attention to detail, documents details appropriately, and effectively articulates recommendations and outcomes both verbally and in writing in both small and large group forums.

Qualifications

• Bachelor's Degree or equivalent in business, health care operations, nursing or other related area, or equivalent combination of education and experience.
• LIC-Registered Nurse (RN) State of Michigan.
• 2 years of related experience.
• Clinical Background Preferred.
• Working in an organization of size and complexity of Corewell Health.
• CRT-Healthcare Compliance, Certified (CHC) - HCCA Health Care Compliance Association.

Career with Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv.
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance.
• Traditional and Roth retirement options with service contribution and match savings.

Eligibility for benefits is determined by employment type and status.

Primary Location SITE - Corewell Health Place - 100 Corewell Drive NW - Grand Rapids

Department Name System Compliance - Corporate

Employment Type Full time

Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8 a.m. - 5 p.m. Days Worked Monday to Friday Weekend Frequency N/A

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category.

We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do.

We invite those that share in our commitment to join our team.

People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 60,000+ dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.