Texas Health Action

Clinical Compliance Manager

Texas Health Action

full-time

Posted on:

Location Type: Hybrid

Location: Austin • Texas • United States

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Salary

💰 $102,335 per year

About the role

  • 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

Requirements

  • Bachelor’s degree in nursing, health information management, healthcare administration, or a related field required; clinical licensure (RN, PA, NP, LVN, RT, etc.) is strongly preferred.
  • Certification preferred: CIC, CPHQ, CCS, RHIA/RHIT, CHC, or other clinical/quality/compliance credentials.
  • 3–5 years of experience in clinical compliance, quality management, HIM/coding, infection control, or clinical operations.
  • Strong working knowledge of clinical documentation standards, coding regulations, accreditation requirements, and payer medical necessity guidelines.
  • Experience with EHR systems, audit tools, incident reporting systems, and clinical quality analytics.
  • Prior experience working with LGBTQIA+ and/or other marginalized communities strongly preferred.
  • Must have basic PC skills that include a combination of working in a Windows Operating System and Microsoft Outlook, Word, and Excel.
  • Understands the importance of maintaining confidentiality; able to maintain confidentiality under HIPAA standards.
  • Must have the ability to exercise a high degree of diplomacy and tact; excellent customer services and interpersonal communication skills; Cultural sensitivity and demonstrated ability to work with diverse people groups.
  • Well-developed verbal and written communication skills in English; Additional language abilities desirable.
  • Ability to work well under pressure with minimal supervision.
  • Ability to effectively interact with persons of widely diverse roles, backgrounds, cultures, and socio-economic classes, those in crises or resistant or negative toward organizations.
  • Ability to apply time management practices to prioritize, schedule and complete work effectively to comply with mandated policies and deadlines.
  • Ability to work on multiple tasks or parts of tasks simultaneously to ensure timely completion of work activities.
  • Must be able to work productively with other departments and employees.
  • Ability to work with professionals from various partners and organizations.
  • Usually works forty (40) hours per week, some weekends may be required.
  • Ability to successfully manage conflict, negotiating “win-win” solutions.
  • Must be able to multi-task, prioritize with strong time management skills.
  • Exceptional follow-through on tasks and assignments
  • Must possess leadership qualities and be able to supervise and secure the cooperation of staff
Benefits
  • Health Care Plan (Medical, Dental & Vision)
  • Retirement Plan (403b)
  • Life Insurance (Basic, Voluntary & AD&D)
  • Paid Time Off (Vacation, Sick & Holidays)
  • Short-Term & Long-Term Disability
  • Training & Development
  • Parental Leave
  • Longevity Pay
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
clinical documentationcodingmedical necessity auditsrisk adjustmentincident reportingroot-cause analysisclinical compliancequality managementclinical policiesclinical quality analytics
Soft Skills
interpersonal communicationcultural sensitivitytime managementconflict managementdiplomacycustomer serviceleadershipability to work under pressureexcellent verbal communicationexcellent written communication
Certifications
CICCPHQCCSRHIARHITCHCclinical licensure (RN, PA, NP, LVN, RT)health information management certificationhealthcare administration certificationquality compliance credentials