Applies systems analysis skills and inductive reasoning skills to determine health care organizations' degree of compliance.
Engages health care organization staff in interactive dialogues on standards-based issues.
Prepares management reports that clearly link individual standards deficiencies with potential systems vulnerabilities.
They are seeking an Acute Care Registered Nurse with Leadership experience in quality, accreditation and/or regulations. They offer comprehensive benefits for their employees for full-time and part-time positions.
Research compliance program benchmarks and requirements.
Write/maintain compliance policies and program descriptions.
Assist compliance vendor oversight activities.
SmithRx is a rapidly growing, venture-backed Health-Tech company aiming to disrupt the PBM sector. They have a mission-driven and collaborative culture that inspires employees to transform the U.S. healthcare system.
Design and/or enhance targeted and annual risk assessments.
Construct specific and effective auditing and monitoring workplans based on risks identified.
Analyze compliance outcomes and ensure detected issues are referred for remediation.
SmithRx is a rapidly growing, venture-backed Health-Tech company aiming to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector. With hundreds of thousands of members onboarded, they foster a mission-driven and collaborative culture, dedicated to transforming the U.S. healthcare system.
Develop and lead the enterprise compliance strategy aligned with institutional growth plans and regulatory expectations.
Oversee preparation and submission of substantive change applications and institutional reporting requirements.
Establish enterprise compliance training framework for corporate and campus leaders.
Cotulla Education transforms lives through hands-on, career-focused education. They empower students to achieve their professional dreams in high-demand fields. With experienced faculty providing personalized support, their graduates emerge as future leaders ready to make a significant impact.
Collaborate with clinic teams to deliver hands-on patient care.
Process prior authorizations, resolve insurance issues, and support financial assistance.
Educate patients on pharmacy services and assist with specialty and retail prescriptions.
Shields Health Solutions is redefining patient care through specialty pharmacy. They are hiring motivated people and seem to have a good employee culture.
Utilizes remote order entry and order verification.
Serves as a consultation resource to medical and nursing staff.
Ensures safe, appropriate, cost effective medication therapies for patients.
Dartmouth Health actively engages in clinical and technological decisions that directly impact patient lives while competently servicing clients. Staffers utilize specialized software and communications platforms that create a vibrant community of connected professionals.
Respond to inbound inquiries from providers, medical office staff, and payers by phone, email, and internal messaging
Support providers with real-time order status updates, prescription processing steps, and plan-specific requirements
Triage escalations and resolve urgent or complex order-level issues efficiently
PHIL is a Series D health-tech startup building a platform that interfaces between doctors, pharmacies, and patients to streamline the process of patients receiving prescriptions. The team at PHIL is a group of like-minded individuals from varying backgrounds, passionate about creating a new and innovative healthcare platform that is focused on patient experience and overall human wellbeing.
You will function as a central knowledge holder in a specialized team within Pharma Regulations & Audits.
You will carry out audits and compliance checks, formulate improvement measures and supervise the implementation.
You will implement projects to improve compliance and quality processes.
Redcare Pharmacy is Europe’s leading online pharmacy driven by innovative technologies and the passion of its employees. The company strives for an inspiring and collaborative work environment where everyone feels valued and contributes to their mission: “Until every human has their health.”
Follows documented process to ensure timely processing of Primary Source Verification completion for initial and recredentialing.
Follows guidelines in alignment with all NCQA, CMS, and state requirements as related to the provider credentialing.
Works with both internal and external stakeholders to resolve complex provider credentialing issues.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers
Responsible for ensuring that the Value Hub adheres to regulatory standards, contract requirements, and internal quality benchmarks.
Analyzing compliance data, preparing detailed reports, and working closely with various departments to maintain and improve compliance and quality standards.
Supporting the understanding of local regulatory requirements, completion of local audits, participation in quality committees, and supporting health plan needs and interactions to ensure consistent implementation of contractual obligations.
CommonSpirit Health has more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services. They are committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside their hospitals and out in the community.
Oversees the work of Learner Compliancy specialists and supports their development and performance management.
Ensures consistent execution of compliance workflows across all learner populations, including extended-term courses.
Monitors and evaluates team KPIs to ensure compliance targets are met or exceeded.
Nightingale Education Group focuses on higher learning in healthcare professions. They elevate education, health, and employment systems through academic achievement, personal growth, and professional development of learners, alumni, and collaborators, while serving diverse communities.
Provides direction and support for on-going program development.
Aligns multiple departments and staff to foster interdepartmental collaboration across the full continuum of care.
Develops program goals and objectives to ensure efficient and cost effective operations consistent with the program's mission and standards.
University of Utah Health is focused on enhancing the health and well-being of people through patient care, research, and education. As a Level 1 Trauma Center, they are nationally ranked and recognized for their academic research, quality standards and overall patient experience.
Initiate communication to communities regarding expensive and non-formulary medication orders.
Keep detailed records of all orders that require communication to the community.
Review Medicare D rejections and prior authorizations, and coordinate with pharmacists or physicians.
Symbria Rx Services delivers patient-centered care to the geriatric population in senior-living and post-acute settings. As one of the few 100% employee-owned companies in healthcare, our business practices are guided strictly by the values to which our employee owners are committed to.
Monitor federal and state laws impacting government programs.
Provide cross-functional guidance for compliance with legal requirements.
Coordinate and support compliance audits, ensuring timely responses.
CareCentrix is focused on healthcare at home, aiming to simplify care delivery and management. They offer services like home health, durable medical equipment, and home infusion, managing care for over 19 million members across the U.S. and Puerto Rico.
Evaluate facility credentialing applications for accuracy and completeness.
Engage with facilities to clarify credentialing-related questions and obtain missing information.
Update and maintain credentialing software systems with necessary facility information.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. They are a national leader in value-based care, serving 200,000+ seniors in 1,500+ communities across 32 states, with a team of more than 1,000 clinicians and professionals.
Review and maintain assigned queue to ensure completeness and accuracy.
Review and quality check license applications for accuracy and completeness.
Monitor and resolve deficiencies, including Board communication as needed.
Medallion is a leading provider operations platform that eliminates administrative bottlenecks for healthcare organizations. With 130M in funding, they empower healthcare operations teams to streamline workflows and improve provider satisfaction.
Lead the oversight of all delegated activities to ensure compliance with CMS, and NCQA requirements.
Serve as the subject matter expert in interpreting compliance and regulatory requirements.
Direct pre-delegation audits, annual audits, required reporting and ongoing oversight of delegates.
Hackensack Meridian Health helps patients live better, healthier lives, and helps team members succeed. They have a culture rooted in connection and collaboration, and employees are considered team members. They are advancing their mission to transform healthcare and serve as a leader of positive change.