Supervisor, Clinical Compliance, RN

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🕒 July 23

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $85k - $91k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

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Guide Healthcare

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2018

⚕️ Healthcare Insurance

🏥 Healthcare

🎯 Recruiter

Healthcare Insurance • Healthcare • Recruitment

Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.

📋 Description

• Supervising and directing the day-to-day operations of the clinical compliance auditors and specialists. • Serving as the clinical services liaison to senior management and other company leaders. • Assisting in developing coordinated and efficient companywide team processes. • Assisting with coordinating orientation, training, continuing education, and ongoing performance monitoring for clinical compliance auditors and other departments as required. • Working with Leadership to promote the staff’s continued professional growth and education. • In conjunction with the Compliance Manager, UM Manager, and PHM Manager, overseeing and assisting with developing and managing the agenda and meeting minutes for the monthly utilization management data reported to the Independent Physician Association (IPA) UM Committee. • Assisting with facilitating UM and PHM Plan development and adherence. • Identifying UM and PHM Plan requirements and assisting in creating auditing guidelines to ensure clinical staff continue meeting the minimum requirements, including quarterly, semiannual, and annual submission requirements set forth in the UM and PHM Plan. • Serving as a secondary reviewer to ensure adherence to the denial process and all denial compliance audit requirements. • Reviewing and ensuring all documentation is submitted in a timely manner. • Supporting the maintenance of confidentiality related to all computer programs, medical records, and other data. • Applying critical thinking skills and decisive judgment while working with minimal supervision. • Ensuring meeting minutes are completed, signed, and uploaded in accordance with UM and PHM Plan requirements. • Assisting with all internal and external audit reviews and submissions. • Completing monthly 30/30 reviews with the clinical compliance auditors and specialists. • Maintaining a professional appearance during on-camera meetings. • Performing other duties as assigned.

🎯 Requirements

• Registered Nurse with an active and unrestricted license in IL. • Three to five years of experience in leading UM and PHM plan and MSA requirement changes. • Experience in a managed care environment with multiple clients. • Experience in the UM and PHM process and managed care. • Strong organizational, written and presentation skills necessary. • High analytical ability to define and describe complex problems. • Ability to prioritize and react based on rapidly changing business needs. • Proficient in the use of medical terminology and nationally recognized medical criteria. • Computer skills including Microsoft Word, Excel, Outlook, PowerPoint etc.

🏖️ Benefits

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs. • Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered. • Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution. • Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. • Additionally, we offer voluntary Life options to keep you and your loved ones protected. • Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times. • Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals. • Support Your New Family: Guidehealth offers paid parental leave to give you the time you need. • Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.