Job Description
Job Title: Compliance Specialist Nurse (Delegation Oversight RN)
Location: Hybrid – Onsite Tuesday to Thursday, Remote Monday & Friday
Employment Type: Contract (Temp-to-Perm Potential)
Schedule: Monday–Friday, 8:45 AM – 4:30 PM
Job Summary:
We are seeking a Compliance Specialist Nurse (RN) to oversee delegated vendor activities (UM, CM, Appeals) and ensure compliance with regulatory and accreditation standards including NCQA and Medicare Part C & D. This role involves auditing, reporting, and presenting findings to the Delegation Oversight Committee.
Key Responsibilities:
- Conduct pre-delegation assessments and ongoing audits of vendor activities
- Prepare audit reports and present findings to oversight committees
- Develop and track corrective action plans (CAPs)
- Ensure compliance with reporting requirements
- Maintain documentation for delegation readiness and compliance
Qualifications:
- Active RN license in Pennsylvania (compact licenses not accepted)
- Minimum 3 years of experience in compliance, accreditation, or regulatory roles within healthcare or managed care
- Strong knowledge of NCQA, Medicare Part C & D, ACA, and QHP requirements
- Proficiency in Microsoft Office Suite, especially Excel
- Experience with Governance Risk Compliance (GRC) tools
- Excellent communication and presentation skills
- High attention to detail and ability to manage multiple priorities
Interview Process:
One virtual interview round leading to an offer.
Job Tags
Permanent employment, Contract work, Temporary work, Work at office, Remote work, Monday to Friday,