Compliance Nurse

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

📋 Description

• Perform clinical assessments of pre- and post-payment claims to ensure compliance.

• Review clinical documentation in relation to coverage policies and service definitions.

• Utilize independent clinical judgment to assess compliance and recognize discrepancies.

• Oversee assigned compliance cases from initiation to resolution.

• Investigate claims of non-compliance.

• Assess case findings and establish suitable corrective measures.

• Keep comprehensive case files in line with regulatory and accreditation standards.

⛳️ Requirements

• Associate's degree in Nursing.

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

• Current North Carolina Licensure as a Registered Nurse (RN).

• A valid driver’s license is required.

• Must reside within the state of North Carolina.

• Ability to travel within the catchment area as necessary.

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

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

• All candidates must successfully pass a drug test as a condition of employment.

🏝️ Benefits

• Competitive benefits package.

• Work-from-home opportunities available for most roles.

• Professional development opportunities.

• Flexible work schedules may be available for certain positions with management approval.

• Health Insurance with no premium for employee coverage.

• Flexible Spending Accounts.

• 24 days of Paid Time Off (PTO) plus 12 paid holidays in 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.