regulatory compliance coordinator

Royal Community Support

<div>Job Title: RN Compliance - Healthcare Compliance Nurse - Clinical Compliance Coordinator
Job Location: Lakewood, New Jersey
Company Name: Royal Community Support
Job Summary:
We are seeking a highly motivated and experienced Regulatory Compliance Nurse to join our team at Royal Community Support. As a key member of our organization, you will be responsible for ensuring compliance with regulatory requirements, overseeing HR compliance, staff credentialing, and quality assurance in a healthcare or DDD setting. If you are a passionate and dedicated professional with a strong sense of regulatory compliance, we encourage you to apply for this exciting opportunity.
Responsibilities:<ul><li>
Provide regulatory oversight and ensure compliance with federal, state, and local regulations</li><li>
Oversee HR compliance, including staff credentialing, training, and performance evaluations</li><li>
Coordinate quality assurance activities to ensure the highest standards of care and services</li><li>
Collaborate with internal stakeholders to ensure effective communication and implementation of compliance initiatives</li><li>
Investigate and resolve compliance-related issues in a timely and efficient manner</li><li>
Develop and maintain comprehensive compliance policies and procedures</li><li>
Provide training and support to staff on compliance policies and procedures</li></ul>
Requirements:<ul><li>
Bachelor's degree in Nursing (BSN) or related field</li><li>
Minimum 5 years of experience as a Regulatory Compliance Nurse or in a related field</li><li>
Strong understanding of healthcare and DDD regulations</li><li>
Excellent communication, documentation, and organizational skills</li><li>
Ability to work independently and collaboratively as part of a team</li><li>
Strong analytical and problem-solving skills</li></ul>
What We Offer:<ul><li>
Competitive salary (TBD)</li><li>
Comprehensive benefits package (TBD)</li><li>
Collaborative and dynamic work environment</li><li>
Opportunities for professional growth and development</li><li>
A chance to make a meaningful difference in the lives of individuals with developmental disabilities</li></ul>
How to Apply:
If you are a motivated and dedicated professional looking for a new challenge, please apply for this exciting opportunity to join our team at Royal Community Support. We look forward to hearing from you!</div>

RN Compliance Healthcare Compliance Nurse RN Quality Assurance Clinical Compliance Coordinator DDD Quality Assurance RN Regulatory Compliance

TruCare Health Services

Job Overview We are seeking a dynamic and detail-oriented Clinical Compliance Coordinator to join our healthcare team. In this vital role, you will oversee and ensure adherence to all clinical compliance standards, including HIPAA regulations, FDA guidelines, and CARF accreditation requirements. Your proactive approach will help maintain the integrity of clinical operations, safeguard patient information, and promote a culture of compliance across the organization. This position offers an exciting opportunity to make a meaningful impact on healthcare quality and safety through meticulous oversight and collaboration.Duties<ul><li>Monitor and enforce compliance with HIPAA privacy and security regulations to protect patient confidentiality and data security.</li><li>Review clinical documentation for accuracy and completeness, ensuring adherence to CPT coding, ICD-9, ICD-10, and ICD coding standards.</li><li>Collaborate with clinical staff to develop and implement policies that align with Medicare, FDA regulations, and CARF standards.</li><li>Conduct regular audits of clinical processes and documentation to identify areas for improvement and ensure regulatory compliance.</li><li>Provide training sessions on compliance topics such as ICD coding updates, Medicare requirements, and FDA guidelines.</li><li>Maintain detailed records of compliance activities, audit findings, and corrective actions taken.</li><li>Serve as a liaison between clinical teams and regulatory agencies during inspections or accreditation reviews.</li></ul>Qualifications<ul><li>Bachelor's degree in healthcare administration, health information management, or related field preferred.</li><li>Proven experience in healthcare compliance management or clinical auditing.</li><li>Strong knowledge of HIPAA regulations, CPT coding, ICD-9/ICD-10 coding systems, Medicare policies, FDA regulations, and CARF standards.</li><li>Excellent analytical skills with keen attention to detail for reviewing clinical documentation and audit reports.</li><li>Effective communication skills to train staff and coordinate with regulatory bodies.</li><li>Ability to interpret complex regulatory language into actionable procedures.</li><li>Certification in healthcare compliance or related areas is a plus. Join us in fostering a compliant environment that prioritizes patient safety, data security, and operational excellence!</li><li>Experience in healthcare, home care, or behavioral health</li><li>Strong organization and attention to detail</li><li>Ability to manage multiple priorities without dropping the ball</li><li>Comfortable using systems (Google Drive, EHR, etc.)</li></ul>Job Type: Full-timePay: From $20.00 per hourApplication Question(s):<ul><li>If you were hired, how would you organize and track?</li><li>Tell me about a time you were responsible for keeping records or files organized and compliant. What systems did you use and how did you make sure nothing was missed?</li></ul>Education:<ul><li>Associate (Preferred)</li></ul>Work Location: In person

Clinical Compliance Coordinator

Sierra Pacific Supply

Job Title: Quality and Compliance Coordinator Location: Sierra Pacific Supply Company(SPSC)Department: Quality Reports To: Chief Operating Officer at SPSC FLSA Status: Fulltime Purpose and Scope:The Quality &amp; Compliance Coordinator supports the maintenance and administration of Sierra Pacific Supply Company&rsquo;s Quality Management System (QMS) to ensure compliance with AS9100, ISO 9001, customer-specific requirements, and applicable regulatory standards. This role serves as the company&rsquo;s primary authority on quality assurance, quality control, compliance, and audit readiness.Responsibilities:Quality Management System (QMS) Administration&middot; Support the maintenance and organization of Sierra Pacific Supply Company&rsquo;s Quality Management System (QMS).&middot; Serve as the Management Representative for AS9100 and ISO 9001 certifications and have organizational freedom and unrestricted access to top management to resolve quality management issues.&middot; Maintain compliance with aerospace traceability, documentation, and record retention requirements.&middot; Support ongoing improvements to quality procedures and quality system documentation.&middot; Assist with preparation of materials and records used during management review meetings.&middot; Serve as the Management Representative and FOD Leader with the responsibility and authority to establish, implement, and maintain the FOD Prevention activities in the facility.Documentation &amp; Work Instructions&middot; Maintain document control processes including revision tracking, controlled distribution, and archival of superseded documents.&middot; Assist with drafting, revising, and formatting quality procedures, work instructions, and operational documents.&middot; Ensure employees have access to the most current controlled documents.&middot; Maintain organized electronic and physical records in accordance with document control requirements.Training &amp; Competency Records&middot; Maintain employee training records and qualification documentation.&middot; Coordinate onboarding and recurring training related to quality procedures, AS9100 requirements, inspection processes, and traceability practices.&middot; Maintain the training record database to ensure employees are properly trained and qualified for assigned responsibilities.Customer &amp; Supplier Quality Documentation (CCA / CAPA Support)&middot; Maintain documentation related to customer and vendor complaints, returns, non-conformances, and corrective action requests.&middot; Lead the investigation and resolution of customer complaints, non-conformances, and corrective action requests (CARs).&middot; Assist with tracking corrective and preventive actions (CAPA) to ensure proper documentation and closure.&middot; Maintain records of supplier-related quality issues and corrective actions and track trends.Audit Coordination&middot; Coordinate scheduling and preparation activities for AS9100 certification audits, ISO audits, customer audits, and internal audits.&middot; Assemble documentation and quality records requested during audits.&middot; Track audit findings, corrective actions, and closure timelines.&middot; Assist leadership in maintaining audit readiness and compliance documentation.KPI &amp; Performance Tracking&middot; Collect and maintain data for quality performance metrics including on-time delivery, supplier performance, customer complaints, internal non-conformances, and corrective action status.&middot; Assist in preparing KPI reports and dashboards used during management review meetings.&middot; Maintain historical records of quality performance metrics.Calibration &amp; Equipment Records&middot; Maintain calibration records for inspection and measuring equipment.&middot; Track calibration due dates and coordinate service or calibration activities as required.&middot; Maintain the master equipment list and calibration tracking records.Supplier Quality Documentation&middot; Maintain supplier certification records and Approved Supplier List (ASL).&middot; Assist with documentation related to supplier qualification and performance monitoring.&middot; Maintain supplier documentation associated with corrective actions and quality communications.Safety &amp; Compliance Support&middot; Assist with maintaining safety training records and compliance documentation.&middot; Support development and maintenance of safety procedures and EHS documentation.&middot; Assist with maintaining OSHA and applicable California safety compliance documentation.Risk &amp; Opportunity Tracking (AS9100)&middot; Assist leadership in maintaining records related to risk and opportunity assessments within the Quality Management System.&middot; Support documentation associated with risk-based thinking and continuous improvement initiatives.&middot; Maintain records of risk evaluations and related action plans when required.Quality Record Control &amp; Retention&middot; Maintain organized quality records in accordance with AS9100 record retention requirements.&middot; Ensure proper filing, indexing, and retrieval of quality documentation including certifications, audit records, training records, and corrective actions.&middot; Support record retention compliance for customer, regulatory, and certification audit requirements.Education and Training: A bachelor&rsquo;s degree in business administration, engineering, quality, information management, or a related field from an accredited college or university is preferred; however, equivalent professional experience and demonstrated competency may be accepted in lieu of a degree.Qualifications and Skills: &middot; 3+ years of experience in a quality or compliance-related role, ideally in aerospace or defense industries.&middot; Strong organizational skills and attention to detail.&middot; Ability to operate independently while collaborating with operations and leadership.&middot; Excellent communication and problem-solving skills.&middot; Practical, solution-oriented mindset suited for a growing aerospace distribution business.Technical Requirements:&middot; Working knowledge of AS9100 and ISO 9001 standards.&middot; Understanding of aerospace traceability and documentation requirements.&middot; Experience in root cause analysis and CAPA systems.&middot; Knowledge of calibration systems and inspection equipment controls.&middot; Experience maintaining training databases and document control systems.&middot; Familiarity with ERP systems and electronic document management systems.&middot; Knowledge of OSHA and EHS compliance standards preferred.Working Conditions:This position requires adaptability to work in both office and warehouse environments, with varying noise levels and temperature conditions.Physical Requirements:&middot; Communication: Engaging in verbal communication to convey detailed or critical instructions to coworkers and management, often requiring clear, loud, or rapid speech.&middot; Hearing: Ability to perceive sounds at normal speaking levels, with or without correction, and effectively receive detailed information through oral communication, including discerning subtle differences in sound.&middot; Repetitive Motions: Performing significant movements involving the wrists, hands, and fingers, particularly during tasks such as data entry, handling tools, or managing warehouse equipment.&middot; Physical Activity: Exerting up to 50 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or move objects. The role may involve a combination of sitting, standing, and walking, with physical activity varying between office and warehouse environments.&middot; Visual Acuity: Close visual attention is required for tasks such as inspecting parts, reviewing documentation, entering data into computer systems, and reading detailed information.Pay: $62,000.00 - $68,000.00 per yearBenefits:<ul><li>401(k)</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li></ul>Work Location: In person

Quality and Compliance Coordinator

The Ohio State University Wexner Medical Center

<div>Regulatory Compliance Assistant to provide support to assure research protocols are in compliance with university, state and federal regulations across research groups managed by the College of Medicine&rsquo;s Center for Clinical Research Management (CCRM); assists with regulatory functions in support of clinical research activity; assists in preparation of protocol submissions to Institutional Review Boards (IRBs) and provides updates on submission status; assists in preparation of other required regulatory documents; distributes approved documents; relays information to clinical research staff; assists with data entry including collecting, entering and maintaining data and documents in the OnCore electronic database and e-Regulatory; assists with monitoring visits; assists with regulatory issues; creates and maintains regulatory files.
Minimum Education Required
High School diploma or GED. Certification or vocational training may be preferred.
Preferred Education
Bachelor's degree, preferably in biological sciences, health sciences, or life sciences
Required Experience
1 year of relevant experience required.
Preferred Experience
2-4 years of relevant experience preferred. Experience in a clinical research capacity desired; computer skills required with knowledge of database software applications desired.
Requires successful completion of a background check. Selected candidate may be requested to complete a pre-employment physical including a drug screen.
FUNCTION/SUBFUNCTION: Research Administration/Research Compliance
CAREER BAND: Individual Contributor-Technical
CAREER LEVEL: T2
This is a hyrbrid position with the majority of job duties being able to be completed remotely; however, individuals may need to come to the office for specific trainings, group meetings/gatherings, etc.
Regular 40 First Shift</div>

Regulatory Compliance Assistant

UC Irvine Health

<div>Overview:
<div>
Founded in 1965, UC Irvine is a member of the prestigious Association of American Universities and is ranked among the nation&rsquo;s top 10 public universities by U.S. News &amp; World Report. The campus has produced five Nobel laureates and is known for its academic achievement, premier research, innovation and anteater mascot. Led by Chancellor Howard Gillman, UC Irvine has more than 36,000 students and offers 224 degree programs. It&rsquo;s located in one of the world&rsquo;s safest and most economically vibrant communities and is Orange County&rsquo;s second-largest employer, contributing $7 billion annually to the local economy and $8 billion statewide. 
 
To learn more about UC Irvine, visit www.uci.edu.</div>
Responsibilities:
<div>
This recruitment is for Temporary Regulatory Affairs Coordinator position through UCI's internal temporary staffing service.
 
 
Duties include, but are not limited to:</div><ul><li>
Ensure successful management of the regulatory aspects of each study conducted through UCI's Center for Clinical Research.</li><li>
IRB review submissions and approval maintenance; initial, amendment, continuos review, and closure.</li><li>
Maintain documents, files, and OnCore records.</li></ul>
Qualifications:
<div>
Required:</div><ul><li>
2-3 years experience in regulatory/IRB and/or clinical research.</li><li>
Ability to read, write, and follow written and oral instructions in English.</li></ul><div></div><div> 
Total Compensation</div><div>
In addition to the salary range listed below, we offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.</div><div></div><div> 
$33.08/hour - $34.48/hour 
 
Conditions of Employment:</div><div>
The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:</div><ul><li>
Background Check and Live Scan</li><li>
Employment Misconduct*</li><li>
Legal Right to work in the United States</li><li>
Vaccination Policies</li><li>
Smoking and Tobacco Policy</li><li>
Drug Free Environment</li><li>Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.
</li></ul><div>The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.</div><ul><li>
California Child Abuse and Neglect Reporting Act</li><li>
E-Verify</li><li>
Pre-Placement Health Evaluation</li></ul><div>
Details of each policy may be reviewed by visiting the following page - https://hr.uci.edu/new-hire/conditions-of-employment.php</div><div> 
TEMPORARY EMPLOYMENT</div><div>
This is a temporary employment recruitment reporting to the UCI Temporary Employment Services (TES) Department. Interviewing and hiring is based on internal hiring needs and how well the candidate's experience matches the assignment requirements. Certain temporary assignments may require clearance of a health physical or require a valid California Driver&rsquo;s License for driving university vehicles.</div><div>
The majority of our temporary positions are Monday &ndash; Friday, 8:00 a.m. &ndash; 5:00 p.m. We also have occasional part-time, weekend, and evening hours available, depending on the assignment. Comprehensive benefits options are also available for temporary employees, including paid vacation, holidays, and sick leave.</div><div>
Please note that we recruit for this position on an on-going basis to build a talent pool of potential candidates. When a position becomes available, we will review applicants at that time. Due to the volume of applications that we receive, only those candidates selected for interviews will be contacted. Thank you for your interest in employment with UCI Temporary Employment Services.</div><div> 
PARKING INFORMATION</div><div>
All visitors, staff, and students are required to purchase parking permits to park on UCI property. If you plan to commute to work via your personal vehicle, I encourage you to review the parking requirements of your work location and parking rates on the UC Irvine Parking and Transportation website</div><div> 
Closing Statement:</div><div>
The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy.
 
 
We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.
 
 
UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact Human Resources at (949) 824-0500 or eec@uci.edu.</div></div>

Temporary Clinical Regulatory Affairs Coordinator

ThyssenKrupp Materials NA, Inc.

<div>Company With around 480 locations in over 40 countries, thyssenkrupp Materials Services is the biggest materials distributor and service provider in the western world. The broad service spectrum offered by the materials experts enables customers to focus on their individual core business. The area of Materials Services spans two strategic areas: global materials distribution as one-stop-shop &ndash; from steel and stainless steel, tubes and pipes, nonferrous metals and specialty materials to plastics and raw materials &ndash; and tailored services in the areas of materials management and supply chain management. An extensive omnichannel architecture offers 250,000 customers worldwide cross-channel, round-the-clock access to more than 150,000 products and services. A highly efficient logistics system ensures that all requested services are smoothly integrated into customer production processes &ldquo;just-in-time&rdquo; or &ldquo;just-in-sequence. thyssenkrupp Aerospace is a subsidiary of the internationally operating thyssenkrupp Group. We focus on supplying aerospace raw materials and finished part logistics to the world&rsquo;s leading aerospace companies and their supply chains. Operating from 35 service centers in 15 countries throughout the Americas, Europe and Asia Pacific enables us to aggregate demand across a single supply chain on behalf of the world&rsquo;s leading OEM&rsquo;s, while at the same time providing a truly responsive local service to meet the needs of individual subcontractors anywhere in the world.
<h2 class="jobSectionHeader">Your responsibilities</h2>
<h2 class="jobSectionHeader">Job Summary</h2>
The Regulatory Compliance Lead Auditor will plan and perform AS9100, product and regulatory Export Administration Regulations (EAR), International Traffic in Arms Regulations (ITAR) and Controlled Unclassified Information (CUI), audits to evaluate and determine thyssenkrupp Aerospace quality systems and/or product compliance to Customer and Regulatory requirements.<h2 class="jobSectionHeader">
Job Description</h2>
Key Accountabilities:<ul><li>
Perform and document pre-audits, registration audits, re-audits and surveillance audits following relevant published standard(s), regulatory requirements and company procedures.</li><li>
May lead audit team and be responsible for successful accomplishment of assigned project</li><li>
Review and forward audit reports, responses to audit nonconformities, and other technical documentation reports to Stakeholders. (Leadership of TKANA)</li><li>
Inform client management through verbal and written communication of compliance issues, relevant standards and regulatory requirements</li><li>
Evaluate product nonconformance related to product processes and specifications</li><li>
Establish and maintain strong professional relationships with all stakeholders</li><li>
Maintain and expand technical expertise in specific product fields</li><li>
Perform other duties as assigned</li><li>
Meet TKANA Employee Attributes / Competencies</li></ul>
This position has been identified as &ldquo;safety sensitive&rdquo; by thyssenkrupp under applicable laws. Accordingly, any application for this position that is considered for employment with thyssenkrupp requires successful completion of pre-employment drug testing, which may include testing for marijuana in accordance with any applicable federal, state, and local laws.
Qualifications:
Minimum Requirements:<ul><li>
Bachelor&rsquo;s Degree in Business or Aerospace discipline or equivalent education and/or experience</li><li>
2 years of experience in conducting regulatory compliance audits</li><li>
4 years of experience in the Aerospace industry with at least 2 years&rsquo; experience in quality assurance and regulatory affairs</li><li>
Computer literacy required includes Microsoft Office applications.</li><li>
Aerospace approved AS9100, AS9110 or AS9120 Lead Auditor Certification</li><li>
Aerospace Regulatory Compliance within Export Regulations (EAR), International Traffic in Arms (ITAR) and Controlled Unclassified Information (CUI)</li><li>
Knowledge of Cybersecurity Maturity Model Certification</li><li>
Technical expertise in product field of Aerospace (AS9100, ITAR, EAR, CUI)</li><li>
Ability to travel up to 50% of time, both domestically and internationally (Canada &amp; Mexico). Valid passport and driver&rsquo;s license required.</li><li>
Broad knowledge of domestic and international regulatory compliance laws and regulations, including specific product directives</li><li>
Ability to read and interpret documentation for compliance with procedures, standards and regulations</li><li>
Ability to communicate with all levels of the work environment including, highly specialized engineers, upper management and regulatory employees</li><li>
Must be highly organized and able to work independently</li><li>
Physical demands and work environment includes office, laptop computer, manufacturing and laboratory environments.</li><li>
Safety Mindset</li></ul><h2 class="jobSectionHeader">
Job Compensation</h2>
Salary Range: $82,052.58 - $123,078.87 annually<h2 class="jobSectionHeader">
Benefits Overview</h2>
We offer competitive company benefits to eligible positions, such as:<ul><li>
Medical, Dental, Vision Insurance</li><li>
Life Insurance and Disability</li><li>
Voluntary Wellness Programs</li><li>
401(k) or RRSP programs with Company Match</li><li>
Paid Vacation and Holidays</li><li>
Tuition Reimbursement</li><li>
And more!</li></ul>
Benefits may vary based on job, country, union role, and/or company segment. Please work with your recruiter or tk representative for applicable benefits information.<h2 class="jobSectionHeader">
Disclaimer</h2>
This is to notify the general public that some individuals/entities are using the thyssenkrupp (&ldquo;TK&rdquo;) name, trademark, domain name, and logo without authorization. They are posing as employees, representatives, or agents of TK and its associated/group companies. These individuals/entities are fraudulently offering jobs online through texts, websites, telephone calls, emails, or by issuing fake offer letters. They are also soliciting jobseekers to deposit money in certain bank accounts or providing jobseekers with fraudulent checks to obtain banking information. 
TK does not ask, solicit, or accept any monies in any form from candidates, job applicants, or potential jobseekers, who have applied to or wish to apply to TK, whether online or otherwise as a pre-employment requirement. TK bears no responsibility for money being deposited/withdrawn therefrom in response to such fake offers. 
TK does not: 
1. Send job offers from free email services like Gmail, Rediffmail, Yahoo mail, etc.; 
2. Request payment of any kind from prospective jobseekers or candidates for employment; 
3. Authorize anyone to collect money or agree to any monetary arrangement in return for a job at TK; 
4. Send checks to job seekers; or 
5. Make job offers through third parties. In the event TK uses professional recruitment services through a third party, offers are always made directly by TK and not by any third parties.
PLEASE NOTE: 
1. TK strongly recommends that potential jobseekers do not respond to such fake solicitations, in any manner; 
2. TK will not be responsible to anyone acting on an employment offer that is not directly made by TK; 
3. Anyone making an employment offer in return for money is not authorized by TK; and 
4. TK reserves the right to take legal action, including criminal action, against such individuals/entities. 
TK follows a formal recruitment process through its own HR department and applications are evaluated by its HR department through pre-defined processes. Please visit our official careers website at https://jobs.thyssenkrupp.com/en to view authentic job openings at TK. 
If you receive any unauthorized, suspicious, or fraudulent offers or interview calls, please email us at tkmna.employee.care@thyssenkrupp-materials.com. 
We shall not accept any liability towards the representation made in any fraudulent communication or its consequences, and such fraudulent communication shall not be treated as any kind of offer or representation by TK or its group companies and affiliates. 
<h2 class="jobSectionHeader">
Your profile</h2></div>

Regulatory Compliance Lead Auditor

Highmark Health

<div><h2 class="jobSectionHeader">Company :
</h2>Highmark Inc.
<h2 class="jobSectionHeader">Job Description :
</h2>JOB SUMMARY
This job is responsible for working with HHO clinical departments in the areas of compliance and process improvement. Serves as a corporate resource regarding accreditation standards, clinical performance and continuous improvement principles. Manages the oversight and development of clinical submissions for regulator inquiries. Oversees development and maintenance of Care Management policies and procedures to ensure accreditation and compliance with NCQA and DMMA requirements. Monitors regulatory changes, industry trends, and contract changes on an ongoing basis. Conducts analysis and oversight of design, development, modification, adaptation, implementation and execution of solutions for improvement of short-term and long-term clinical and operational excellence. Collaborates with various organizational leaders to prepare briefings or reports and conduct data analyses. 
 
ESSENTIAL RESPONSIBILITIES
<ul><li>Serve as an internal project lead to ensure alignment and consistency in the organization's contractual clinical performance measurement across Care Management.
</li><li>Manage and coordinate department activities including but not limited to: policy and procedure development and revision, individual staff audits, and overall operations to ensure compliance to standards and regulations. Serve as the point of contact and Highmark Health Options clinical representative to state regulators.
</li><li>Continuously examine processes and procedures to identify opportunities for improvement and refinement.
</li><li>Perform internal clinical audits for the purpose of quality assurance, and to assure compliance with respect to regulatory requirements and corporate policies/procedures.
</li><li>Recommend and develop corrective action plans to management. Oversee final plan implementation and communication.
</li><li>Effectively communicate outcomes, data analysis, complex processes and action plans to division/unit staff, corporate partners across departments and external customers.
</li><li>Research federal and state regulations and other regulatory materials, various business requirement contracts and subcontracted delegate entity to ensure compliance.
</li><li>Coordinate department accreditation, oversight and compliance activities with regulatory guidelines/agencies, including but not limited to NCQA and DMMA.
</li><li>Other duties as assigned or requested.
</li></ul>EXPERIENCE
Required
<ul><li>5 years of experience as working in a clinical setting.
</li><li>3 years of experience as case management/managed care (with specific knowledge of quality monitoring, compliance and/or regulatory processes)
</li>1 year of experience in evaluating, implementing or revising work processes 
<li>
 </li></ul>Preferred
<ul><li>3 years of experience in performing auditing/monitoring functions.
</li><li>3 years of experience in creating tools, training documents and educational materials geared to adult learners.
</li>3 years of experience in healthcare/health insurance industry. 
<li>
</li></ul>SKILLS
<ul><li>Workforce development and resource management with excellent team building and professional development skills
</li><li>Strong leadership, collaboration, and motivational skills
</li><li>Staff/project management
</li><li>Ability to relate to all levels of management and staff as well as individuals external to the corporation
</li><li>Ability to multi task and perform in a fast paced, and often intense environment
</li><li>Excellent written and verbal communication skills
</li><li>Ability to analyze data, measure outcomes and develop action plans
</li><li>Be enthusiastic, innovative and flexible.
</li><li>Ability to prioritize work demands and meet deadlines
</li><li>Excellent computer and software knowledge and skills
</li></ul>EDUCATION
Preferred
<ul><li>Bachelor&rsquo;s degree in business, health care administration, nursing, or other related program.
</li></ul>LICENSES or CERTIFICATIONS
Required
<ul><li>Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC), LCSW, LSW, LPC or related clinical licensure, Within 45 days of hire.
</li></ul>Preferred
None 
<ul><li>
</li></ul> 
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office- or Remote-based
Teaches / trains others
Occasionally
Travel from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
 
 
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 
 
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company&rsquo;s Handbook of Privacy Policies and Practices and Information Security Policy.
 
 
Furthermore, it is every employee&rsquo;s responsibility to comply with the company&rsquo;s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$67,500.00
Pay Range Maximum:
$126,000.00
Base pay is determined by a variety of factors including a candidate&rsquo;s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice</div>

Clinical Compliance Coordinator (Remote)

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