🚀 Compliance Specialist Nurse (Delegation Oversight RN)

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: Monday–Friday, 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.