Director Clinical Compliance RN

Job Summary and Qualifications

The Clinical Compliance Director position will work on various audit engagements with team members at various levels and will receive a formal evaluation yearly.

What you will do in this role

• Directs and coordinates clinical compliance team reviews.
• Oversees reviews of hospital/center systems to ensure compliance with applicable legal, regulatory and licensure requirements as defined by CMS, state regulations, and company policy.
• Reviews detailed reports specifying compliance issues identified during the audit.
• Demonstrates a thorough understanding of CMS, Joint Commission, and State Health Department regulations, regarding post-acute services, admission status, licensure/certification, clinical trials, core measures, National Coverage Determination requirements, and other review areas.
• Participates in the audit quality assurance program.
• Serves as a mentor to Senior Manager/Manager personnel to help them reach their full potential – including conducting meaningful and annual performance reviews, serving as a positive role model, and assisting them in designing and implementing individual career development plans.
• Understands HCA Healthcare’s business and the healthcare industry from a global perspective by recognizing business trends and emerging technical and industry developments of relevance and communicates these to the client engagement team and applicable management personnel.
• Serves as a trusted business advisor by providing client management value-added advice.
• Provides input and guidance in the development of, as well as the review of the detailed audit/review programs particularly focusing on complex audit issues.
• Demonstrates working knowledge of Medicare rules and regulations and stays abreast of regulatory changes.
• Presents quarterly/annual updates to members of the Executive Management Team of HCA Healthcare.
• Provides ongoing consultation for facility, Division, and Group management.
• Approves executive summaries and audit reports, identifying the key issues for discussion with facility, Division, and Group management.
• Stays abreast of company-wide initiatives and effectively evaluates impact on the planned audit approach.
• Utilizes and encourages the use of computer-based tools to continually develop innovative audit approaches and enhance internal audit services.
• Develops strategies to improve audit effectiveness and efficiency and proposes modifications to current procedures.
• Recommends and helps implement management decisions for the department.
• Leads efforts related to other educational and administrative matters (e.g. professional development programs, process improvement team initiatives, recruiting efforts, and special projects).

Qualifications

• Active RN Licensure with 7 or more years’ experience
• College Graduate (from accredited School of Nursing), Master degree preferred
• Nursing management/supervisory experience
• Case Management, Utilization Management, Quality, hospital, rehab, skilled, consulting experience is preferred
• Ability to travel up to 20%

Benefits

• Medical, Dental, Vision, Life Insurance and Flexible Spending
• Paid Time Off (PTO) and Personal Leave
• 401K (100% annual match - 3% to 9% of pay based on years of service)
• Academic Assistance and Reimbursements for Tuition and Student Loans
• Employee Discounts including Tickets, Retail, Mental Health Apps, Education Apps, Identity Theft Protection etc.
• Home, Auto, and Pet Insurance
• Employee Stock Purchase Program (ESPP)
• Short Term & Long Term Disability coverage
• Adoption Assistance
• Legal Benefits