Clinical Compliance Program Manager

📋 Description

• Ensure adherence to WellSky's Utilization Management and Compliance Program.

• Act as a clinical authority on state and federal regulations.

• Analyze and present data to identify best practices within post-acute healthcare environments.

• Facilitate initiatives related to performance measurement and outcomes.

• Ensure the organization complies with CMS, NCQA, and other regulatory standards.

• Stay informed about relevant regulatory updates.

• Assist in the integration of regulatory changes into operational practices.

• Adhere to state, federal, and organizational standards.

• Aid in the formulation and enforcement of policies that align with Utilization Management and Compliance requirements.

• Complete and successfully submit CMS reports.

• Conduct Root Cause Analysis (RCA) in collaboration with Operational teams.

• Perform regular compliance audits in accordance with CMS UM standards.

• Develop and oversee the implementation of internal audit protocols.

• Generate and validate reports to track performance and compliance.

• Prepare for regulatory, accreditation, and contractual audits.

• Contribute to the remediation and documentation of audit findings.

• Undertake other responsibilities as assigned.

⛳️ Requirements

• Minimum of 4-6 years of relevant professional experience.

• Advanced working knowledge of CMS UM audits.

• At least 2-3 years of compliance experience focusing on CMS and health plan audits.

• A minimum of 1-2 years implementing CMS final rule changes and managing process change.

• Bachelor's Degree or equivalent professional experience.

• Active, unrestricted license: RN, PT, OT, or SLP, with a bachelor’s degree in a related field or a combination of education and experience that includes relevant clinical experience and a strong working knowledge of CMS standards and guidelines.

• Experience with NCQA audits.

• Ability to prioritize, plan, and manage multiple tasks and demands simultaneously, even with competing deadlines.

• Proficient in data manipulation and sorting for analytics and reporting purposes.

• Previous experience managing client compliance SLAs and ensuring successful compliance with SLA requirements.

🏝️ Benefits

• Comprehensive medical coverage including Rx, dental, and vision benefits.

• Mental health support via Employee Assistance Program (EAP).

• Generous paid time off, along with 13 paid holidays.

• 100% vested 401(K) retirement plans.

• Educational assistance of up to $2500 per year.