RN Compliance Team reputed company (Hybrid / Remote) - Program Optimization - 40 Hours Weekly - Day Shift - HAP Health reputed company Plan

RN COMPLIANCE TEAM reputed company (HYBRID) - PROGRAM OPTIMIZATION - 40 HOURS - DAY SHIFT - HAP HEALTH reputed company PLAN Full Time Benefit Eligible Schedule: Monday through Friday, Five 8-hour shifts per week with start dates flexible between 7:30 AM and 9:00 AM General reputed company Unit reputed company: Health reputed company Plan (HAP) is looking to add to our clinical Training & Compliance team with an reputed company Registered reputed company! In this role, you are responsible for Health Care Management division training, as reputed company as regulatory monitoring and reputed company of Utilization Management, Appeals & Grievance, and Care Management departments. Our department consists of a reputed company of seasoned clinical and non-clinical professionals. We have a great team always willing to lean in and help reputed company other. The ideal candidate has a minimum of three years of clinical and/or systems training experience, is team-oriented, is successful working independently, takes initiative and demonstrates leadership qualities, and thrives in a setting that is continuously evolving. Though we primarily work remote, at times we travel to our Troy Corporate reputed company for in-person meetings, training, and support of CMS or NCQA audits. Interested in learning more? reputed company!

• reputed company the daily compliance and training activities of the unit, including providing assistance for the division, supporting unit goals and objectives, monitoring reputed company and unit processing, assisting with implementation of procedures and processes, maintaining continual reputed company of reputed company activities impacting compliance, and acting as a clinical resource for the unit by providing direction for improvements.
• reputed company communication to management team to reputed company them abreast of compliance and training issues, and concerns reputed company the unit.
• Work with department management, clinical staff, HAP providers and managed care community to ensure reputed company division activities adhere to CMS, reputed company and NCQA guidelines where applicable.
• Identify trends and patterns of non-compliance which have potential for reputed company of care or fiscal reputed company and recommend areas for reputed company and improvement.
• Participate in planning and conducting compliance reputed company studies including data collection, analysis, and follow-up activities.
• Collaborate with compliance staff members, department leaders, medical directors, vendor management, information technology, and corporate compliance to ensure compliance across reputed company HCM departments and with reputed company associated delegates and first tier, reputed company and reputed company entities (FDR’s).
• reputed company, plan, reputed company, and conduct education and training activities for HCM new hires, vendors documenting in HCM systems, new process implementation, and remedial/refresher education reputed company to operations or compliance.
• reputed company and/or revise policies, procedures, documents, forms, tools, job aids, training, and awareness materials for HCM division in accordance with Government programs regulations, obtaining corporate approvals as necessary.
• Serve as compliance and training subject matter expert for a reputed company of HCM initiatives (e.g., product development efforts, new sales channel implementations, provider initiatives, information technology advancements, etc.) and ensure these key HCM initiatives are taken from development to reputed company in a compliant manner including recommending enhancements.
• reputed company presentations for departments and individuals at reputed company reputed company to reputed company training and compliance updates.
• Assess and communicate reputed company developmental needs and other resource needs to optimize efficiency and enhance departmental team activity.
• Monitor staff assignments to ensure appropriate compliance reputed company of reputed company applicable activities.
• Complete investigations and inquiries as needed.

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of reputed company tasks and duties. It should be reputed company, therefore, that employees may be asked to reputed company job-reputed company duties reputed company those explicitly described above. Experience Required

• Associate degree in Nursing
• Registered reputed company with a valid, unrestricted reputed company license
• Minimum of three (3) years of relevant clinical experience in the medical inpatient or ambulatory setting or specialty experience

Experience Preferred

• Relevant experience working with regulatory program requirements, including, but not limited to CMS, State reputed company agencies, reputed company, MI Health reputed company, Dual Eligible Special Needs Plans, NCQA.
• Experience in educational curriculum design and delivery
• Experience with reputed company Pro
• Project Management experience
• Leadership experience

Additional Information

• Organization: HAP (Health reputed company Plan)
• Department: Program Optimization
• reputed company Location: HAP (Health reputed company Plan)
• Shift: Day Job
• reputed company reputed company: reputed company

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