Compliance Nurse Manager

About the Role

The Registered Nurse (RN) – Compliance Manager ensures organizational adherence to federal, state, and healthcare regulations related to clinical operations.

Responsibilities

• Conducts clinical audits of medical records, care plans, and documentation to maintain compliance.
• Monitors adherence to Medi-Cal, CMS, and state-specific program requirements.
• Identifies risks, trends, and compliance gaps; prepares audit reports and presents findings.
• Supports Quality Assurance and Performance Improvement (QAPI) initiatives by developing dashboards and corrective plans.
• Participates in internal/external audits, ensuring policies align with current standards.
• Collaborates with clinical leadership to address compliance issues and supports interdisciplinary meetings.
• Maintains accurate records of audits, findings, and corrective actions; ensures timely follow-up.
• Serves as a resource for compliance questions and guidance.
• Supports reporting requirements for regulatory agencies and leadership.

Requirements

• Active RN license in applicable states.
• 3–5 years of nursing experience; 1–2 years in compliance, QA, or utilization review.
• Knowledge of Medi-Cal, CMS, and managed care requirements.
• Strong analytical, communication, and organizational skills.
• Proficiency in EMR systems and MS Office.
• High attention to detail and ability to interpret complex regulations.