Process Intelligence Program Director
Guidehouse
Clinical Compliance Program Manager
WellSky
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Ensure compliance with WellSky's Utilization Management and Quality Improvement Program
- Analyze and present data to establish best practices across post-acute health care settings
- Facilitate activities related to performance measurement and outcomes
- Ensure the organization meets CMS, NCQA, and other regulatory standards
- Stay updated on relevant regulatory changes
- Support the integration of regulatory changes into practices
- Develop and enforce policies aligned with program requirements
- Complete and submit CMS reports
- Conduct Root Cause Analysis (RCA) with Operational teams
- Conduct compliance audits based on CMS UM standards
- Develop internal audit protocols in compliance with CMS regulations
- Generate and validate reports to monitor performance and compliance
- Prepare for regulatory and contractual audits
Requirements
- At least 4-6 years relevant work experience
- Advanced working knowledge of CMS UM audits
- At minimum, 2-3 years of compliance experience focused on CMS and health plan audits
- At minimum, 1-2 years of implementing CMS final rule changes and managing change management of processes
- Bachelor's Degree or equivalent work experience
Benefits
- Excellent medical, dental, and vision benefits
- Mental health benefits through TelaDoc
- Prescription drug coverage
- Generous paid time off, plus 13 paid holidays
- Paid parental leave
- 100% vested 401(K) retirement plans
- Educational assistance up to $2500 per year
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data analysisperformance measurementRoot Cause Analysiscompliance auditsaudit protocolsreport generationregulatory compliancechange managementpolicy developmentquality improvement
Soft skills
communicationorganizationalfacilitationpresentationleadership
