RN Clinical Regulatory Specialist
Company: Oscar Health
Location: Tempe
Posted on: May 9, 2022
Job Description:
Job DescriptionHi, we're Oscar. We're hiring a Clinical
Regulatory Specialist to join our Clinical Training and Quality
team.Oscar is the first health insurance company built around a
full stack technology platform and a focus on serving our members.
We started Oscar in 2012 to create the kind of health insurance
company we would want for ourselves—one that behaves like a doctor
in the family.About the role:As an RN on the Clinical Quality team,
you will ensure that our case management programs and delegates are
compliant with organizational, federal and state regulatory
requirements. Your work will have an impact on the success of our
departmental programs along with delegate compliance and
performance, and for Oscar as a whole. You will report to Director
of Clinical Quality and Training.This is a remote / work-from-home
role. You must reside in one of the following states: Arizona,
California, Connecticut, Florida, Georgia, Illinois, Maryland,
Massachusetts, Michigan, New Jersey, New Mexico, New York, North
Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Utah,
Virginia, or Washington. Note, this list of states is subject to
change.Responsibilities:
- Learn, and stay updated on current NCQA, regulatory and
organizational requirements and train staff and leadership in how
to comply with these requirements.
- Lead regulatory oversight for the Clinical Care Team - maintain
organizational readiness for NCQA, regulatory and external client
audits through coordination of and participation in onsite/virtual
audit surveys.
- Work with Oscar Compliance, Delegate Oversight and Quality
Improvement departments to maintain organizational compliance and
coordinate audit activities.
- Audit clinician documentation for compliance with regulatory
requirements; identify trends and develop action plans in
collaboration with staff and department leaders to reduce
identified risks.
- Work with your partners to ensure department compliance with
state and federal regulations and coordinate delegate information
needed for external regulatory audits (e.g., CMS program audits,
state regulatory audits)
- Conduct pre and post-delegation audits of CM/CCM delegates
against federal and state regulatory requirements working with
internal delegate account managers to help any findings
identified.
- Monitor department and delegate performance to ensure
compliance with regulatory requirements and internal
standards.
- Draft, coordinate approval, and update department and program
P&P's in partnership with legal and compliance.
- Analyze organizational performance data and create written
documents for presentation work in provider Joint Oversight
Committees and organizational subcommittee meetings.
- Write and coordinate implementation of corrective action plans
post audits to address identified issues.
- Consult with CCT leadership re: compliance considerations when
developing/changing department workflows and documentation.
- Other assignments as assignedRequirements:
- Bachelor's Degree from an accredited university or equivalent
experience
- Active and unrestricted nursing license in state of
residence
- 2+ years of work experience in some or all of the
following:
- Experience writing program descriptions, processes, or policy
documents
- Experience presenting clinical and regulatory compliance
information to large committees in virtual settings
(videoconferencing)
- Computer/tech-savvy- intermediate or advanced skill level in
the development and use of spread sheets, power points, word
documentsBonus points:
- Experience working with health insurance organizations to
comply with NCQA, Medicare, Medicaid and other regulatory
requirements for health insurers.
- Master's degree, CCM or CPHQ certification
- Experience presenting to executive leadershipThis is an
authentic Oscar Health job opportunity. Learn more about how you
can safeguard yourself from recruitment fraud here. Life at Oscar:
At Oscar, being an Equal Opportunity Employer means more than
upholding discrimination-free hiring practices. It means that we
cultivate an environment where people can be their most authentic
selves and find both belonging and support. We're on a mission to
change health care -- an experience made whole by our unique
backgrounds and perspectives.We aim to make health care affordable
and accessible for all, and apply this same vision to our perks and
benefits, including: medical benefits, generous paid-time off, paid
parental leave, retirement plans, company social events, stocked
kitchens, wellness programs, and volunteer opportunities.Pay
Transparency Policy:Oscar ensures that you won't be discharged or
discriminated against based on whether you've inquired about,
discussed, or disclosed your pay. Read the full policy
here.Reasonable Accommodation:Oscar applicants are considered
solely based on their qualifications, without regard to applicant's
disability or need for accommodation. Any Oscar applicant who
requires reasonable accommodations during the application process
should contact the Oscar Benefits Team (accommodations@hioscar.com)
to make the need for an accommodation known.To protect the health
and safety of our employees, we require any employee conducting
in-person work* to be fully vaccinated against COVID-19 by their
start date. If you are unable to be vaccinated due to medical or
protected religious reasons, please reach out to our Benefits team
at accommodations@hioscar.com to submit an accommodations
request.*Note: In-person work includes: employees required to work
from our offices, employees conducting sales work in the field and
employees conducting at-home or in-person visits with members.
Keywords: Oscar Health, Tempe , RN Clinical Regulatory Specialist, Healthcare , Tempe, Arizona
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