Senior Compliance Oversight Specialist (RN)
Core
Conduct audit, oversight, and monitoring activities to assess compliance with contractual and regulatory requirements for government-sponsored health care programs, specifically focusing on care management and utilization management.
Role type
Senior Compliance Oversight Specialist (RN)
Builds
Monitoring and auditing tools to evaluate internal and third-party compliance with clinical aspects of government-sponsored health care program requirements.
Domain
Healthcare compliance and regulatory oversight
Required skills
Nursing practice, audit execution, regulatory compliance analysis, corrective action plan evaluation, risk assessment, contract assessment, compliance advisory, report writing, stakeholder collaboration
Preferred skills
Care management experience, utilization management experience, Certified in HealthCare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE)
Responsibilities
Prepare written reports on audit findings and recommendations, collaborate to direct compliance issues to appropriate channels, review and evaluate corrective action plans, support management in developing monitoring tools, educate staff and third parties on compliance requirements, assess new government program contracts, assist in identifying compliance risks, serve as a compliance advisor to business units.
Seniority
Senior, hands-on IC
