Compliance Nurse

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Conduct clinical compliance assessments and review claims to ensure they meet regulatory and coverage standards.

• Utilize clinical expertise to evaluate documentation, ascertain compliance, and implement corrective measures.

• Perform clinical evaluations on pre- and post-payment claims to confirm adherence to compliance standards.

• Analyze clinical documents against coverage policies and service definitions.

• Exercise independent clinical judgment to assess compliance and pinpoint discrepancies.

• Oversee assigned compliance cases from the initial intake stage to resolution.

• Investigate claims of non-compliance thoroughly.

• Assess case outcomes and decide on suitable corrective actions.

• Ensure comprehensive case files are maintained in line with regulatory and accreditation requirements.

⛳️ Requirements

• An Associate's degree in Nursing is required.

• At least one (1) year of experience with populations including physical health, behavioral health, mental health, substance use, developmental disabilities, and/or co-occurring disorders.

• Must hold an active North Carolina Licensure as a Registered Nurse (RN).

• A valid driver’s license is necessary.

• Candidates must reside in North Carolina.

• Ability to travel within the designated catchment area as needed.

• Preferred: Experience in both physical healthcare and behavioral healthcare settings.

• Preferred: Background in clinical healthcare audits, monitoring, or reviews.

• All applicants must successfully pass a drug test as a prerequisite for employment.

🏝️ Benefits

• A collaborative and mission-oriented workplace environment.

• Competitive benefits package and work-from-home opportunities for the majority of roles.

• Professional development opportunities within a diverse and inclusive culture.

• Flexible work schedules may be available for certain positions, contingent upon management approval.

• Work-from-home options are available for most roles.

• Health Insurance with no premium for employee coverage.

• Flexible Spending Accounts.

• 24 days of Paid Time Off (PTO) plus 12 paid holidays within your first year.

• NC Local Government Retirement Pension (defined-benefit plan).

• 401k plan with a 5% employer match and immediate vesting.

• Qualifying employer for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend for remote work supplies.