Texas Health Action

Compliance

• Lead clinical documentation, coding, and medical necessity audits (E/M, telehealth, specialty services, risk adjustment) and deliver actionable findings, provider education, and trend analysis
• Provide compliance oversight of provider competency, onboarding, credentialing, and privileging processes in alignment with regulatory and accreditation requirements
• Support clinical governance through participation in peer review, performance reviews, quality councils, and multidisciplinary committees
• Oversee infection prevention and clinical safety compliance, including immunization protocols, exposure control, incident reporting, and environmental rounds
• Identify clinical safety risks, conduct incident reviews and root-cause analyses, and track remediation to completion
• Drive regulatory readiness for accreditation surveys, payer audits, and inspections through gap analysis and compliance assessments
• Provide governance and oversight for peer review and utilization review programs to ensure appropriateness of care and adherence to payer and evidence-based standards
• Lead development, review, and implementation of clinical policies, procedures, and practice guidelines aligned with evidence-based standards
• Develop and deliver system-wide education on clinical compliance, documentation accuracy, emerging regulations, and quality standards
• Monitor, analyze, and report clinical compliance metrics, audit results, and risk trends to clinical and executive leadership
• Partner closely with Continuous Quality Improvement (CQI), Risk, and Corporate Compliance teams to translate regulatory findings into sustainable quality improvement initiatives

Clinical Compliance Manager

Bilingual

• Supports status-neutral engagement activities that involve access to HIV biomedical interventions for prevention and care services;
• Provides direct care to individuals wishing to engage in services including, but not limited to conducting intake and assessments for HIV care, PrEP/PEP and/or gender-affirming care, delivering brief individual and group interventions sessions, providing sexual health education and counseling, assisting patients with navigating insurance/benefits, participating in community engagement and outreach, and scheduling appointments;
• Identifies and addresses a patient’s psychosocial barriers to accessing care and facilitates linkage to supportive services and relevant programs;
• Monitors issues affecting patient access, adherence, and/or retention in care. Maintains up-to-date knowledge of internal and external resources to ensure the continuum of care obtained and works to remove any barriers to services;
• Collects and analyzes data to identify program progress, and effectively manages operations by utilizing quality improvement tools;
• Acts as a liaison between local agencies with the functions and operations of the program;
• Interprets program guidelines, policies, and procedures for operations;
• Participates in quality improvement efforts by assisting in making required adjustments and promoting program innovation. Helps to establish and implement goals, objectives, policies, procedures, and systems for the clinic;
• Maintains confidentiality and HIPAA compliance according to the clinic’s policies and procedures; and
• Performs related duties and fulfills responsibilities as required.

Clinical Compliance Manager

Bilingual Patient Advocate – Spanish, English