Clinical Compliance Manager - RN

A company is looking for a Clinical Compliance Program Manager who will ensure compliance with Utilization Management and Quality Improvement Program regulations.

Key Responsibilities :

Facilitate performance measurement activities and ensure compliance with CMS, NCQA, and regulatory standards

Assist in developing and enforcing policies aligned with Utilization Management and Quality Improvement Program requirements

Conduct compliance audits and prepare for regulatory and accreditation audits

Required Qualifications :

4-6 years of relevant work experience

Advanced knowledge of CMS UM audits with 2-3 years of compliance experience

1-2 years of experience implementing CMS final rule changes

Bachelor's Degree or equivalent work experience