Complnc Specialist 3 - Registered Nurse

Please be advised the position requires RN licensure in the comments and that only applicants who possess RN licensure will be selected for interviews.

Job Summary- Under broad supervision, may plan, organize or coordinate the activities of an assigned program, reviews, monitors, and ensures compliance with assigned program area’s policies and procedures. 

Primary Duties & Responsibilities-

• Performs job responsibilities with minimal supervision
• Serves as job expert or organization resource in assigned areas
• May supervise and/or direct the work of others
• Conducts on-site reviews, audits or surveys of clinical and treatment facilities, regulated entity operations and program management
• Conducts utilization reviews, peer reviews, evaluation activities and all other reviews on a scheduled basis
• Coordinates investigations involving noncompliance in facilities, community programs, regulated entity operations and other related programs
• Coordinates the data management and quality assurance functions
• Determines compliance with applicable state and or federal rules and regulations
• Develops, implements, and evaluates the surveillance of utilization review process to ensure quality services
• Monitors, tracks, and maintain records on compliance
• Plans and evaluates outcome studies and or compliance findings
• Plans, develops, schedules, and implements surveys and complaint investigations for licensure or certification of regulated facilities
• Plans, organizes, and directs the certification reviews, reviews new rules and service site applications
• Recommends programmatic and/or operational changes-based review, audit or survey results
• Research and analyzes state codes, federal regulations and industry manuals regarding forms, policies and procedures
• Reviews applications for accuracy and compliance with guidelines regulations and laws
• Performs investigations and/or audits according to established rules, regulations and other statutes

 Minimum Qualification:

Registered Nurse (RN) required

• Some positions may require a certification or licensure
• Some positions may require a valid driver’s license