The Judge Group
Compliance Specialist Nurse (Delegation Oversight RN)
The Judge Group, Philadelphia, Pennsylvania, United States, 19117
Job Title:
Compliance Specialist Nurse (Delegation Oversight RN) Location:
Hybrid
Onsite Tuesday to Thursday, Remote Monday & Friday Employment Type:
Contract (Temp-to-Perm Potential) Schedule:
MondayFriday, 8:45 AM
4:30 PM
Job Summary: We are seeking a Compliance Specialist Nurse (RN) to oversee delegated vendor activities (UM, CM, Appeals) and ensure compliance with regulatory and accreditation standards including NCQA and Medicare Part C & D. This role involves auditing, reporting, and presenting findings to the Delegation Oversight Committee.
Key Responsibilities: Conduct pre-delegation assessments and ongoing audits of vendor activities Prepare audit reports and present findings to oversight committees Develop and track corrective action plans (CAPs) Ensure compliance with reporting requirements Maintain documentation for delegation readiness and compliance
Qualifications: Active RN license in Pennsylvania (compact licenses not accepted) Minimum 3 years of experience in compliance, accreditation, or regulatory roles within healthcare or managed care Strong knowledge of NCQA, Medicare Part C & D, ACA, and QHP requirements Proficiency in Microsoft Office Suite, especially Excel Experience with Governance Risk Compliance (GRC) tools Excellent communication and presentation skills High attention to detail and ability to manage multiple priorities
Interview Process: One virtual interview round leading to an offer.
Compliance Specialist Nurse (Delegation Oversight RN) Location:
Hybrid
Onsite Tuesday to Thursday, Remote Monday & Friday Employment Type:
Contract (Temp-to-Perm Potential) Schedule:
MondayFriday, 8:45 AM
4:30 PM
Job Summary: We are seeking a Compliance Specialist Nurse (RN) to oversee delegated vendor activities (UM, CM, Appeals) and ensure compliance with regulatory and accreditation standards including NCQA and Medicare Part C & D. This role involves auditing, reporting, and presenting findings to the Delegation Oversight Committee.
Key Responsibilities: Conduct pre-delegation assessments and ongoing audits of vendor activities Prepare audit reports and present findings to oversight committees Develop and track corrective action plans (CAPs) Ensure compliance with reporting requirements Maintain documentation for delegation readiness and compliance
Qualifications: Active RN license in Pennsylvania (compact licenses not accepted) Minimum 3 years of experience in compliance, accreditation, or regulatory roles within healthcare or managed care Strong knowledge of NCQA, Medicare Part C & D, ACA, and QHP requirements Proficiency in Microsoft Office Suite, especially Excel Experience with Governance Risk Compliance (GRC) tools Excellent communication and presentation skills High attention to detail and ability to manage multiple priorities
Interview Process: One virtual interview round leading to an offer.