Clinical Compliance Coordinator (remote)

Highmark Health

Working At Home, DE, United States
Base: $79,300.00 - $127,100.00; bonus/equity: not ...
Fully remote
Ncqa and dmma requirements
Clinical performance measurement
Policy and procedure development
This role serves as a corporate resource regarding accreditation standards, clinical performance, and continuous improvement principles, managing oversight and development of clinical submissions for regulator inquiries

Job Summary

  • This role serves as a corporate resource regarding accreditation standards, clinical performance, and continuous improvement principles, managing oversight and development of clinical submissions for regulator inquiries.
  • The Clinical Compliance Coordinator will manage and coordinate department activities including policy and procedure development, individual staff audits, and overall operations to ensure compliance to standards and regulations.
  • The position requires continuous examination of processes and procedures to identify opportunities for improvement and refinement, performing internal clinical audits for quality assurance and recommending corrective action plans.

Matching Summary

This role serves as a corporate resource regarding accreditation standards, clinical performance, and continuous improvement principles, managing oversight and development of clinical submissions for regulator inquiries.

Salary

Base: $79,300.00 - $127,100.00; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • NCQA and DMMA requirements
  • clinical performance measurement
  • policy and procedure development
  • internal clinical audits
  • federal and state regulations

Nice-to-have

  • innovative and flexible
  • team building skills
  • adult learners training
  • healthcare/health insurance industry

Key Requirements

  • 5 years clinical setting experience
  • 3 years case management/managed care experience
  • 1 year work process evaluation experience
  • 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

Work Rights

Not specified

Tailored Resume

Cover Letter