1,873 Medical Compliance jobs in the United States

Job Description

NANA Healthcare Management  manages multiple behavioral health and detoxification treatment centers within the behavioral health industry. With a focus on evidence-based, client-centered treatment programs that offer clients with all levels of need therapeutic interventions in a warm, welcoming environment, NANA Healthcare Management aims to provide clients with care that meets them where they are at and helps them "Be the great person they were always meant to be."

NANA Healthcare Management is seeking a Nursing / Medical Compliance Liaison to ensure regulatory readiness and promote quality client care across all facilities in a behavioral health setting. 

Schedule:  8:30am-5:00pm
Pay:  $60,000-$65,000 annually
Type: Full-time

The Nursing/Medical Compliance Liaison audits and monitors medication records, vitals documentation, and nursing notes to ensure regulatory compliance and promote quality client care across all levels of service. This role serves as the bridge between clinical nursing operations and the compliance team.

Knowledge and Training:

• Adhere to Confidentiality requirements as outlined in 42 CFR, Part 2.
• Must have the ability to interact with staff in a professional manner.
• The ability to handle stressful and demanding situations
• Proficiency in reviewing MARs, vitals, physician orders, and nursing documentation.
• Familiarity with DBHDD, DCH, Joint Commission, and insurance requirements for nursing compliance.
• Ability to identify documentation gaps and trends in medication administration and health monitoring.
• Experience working collaboratively across clinical, nursing, and compliance teams.
• Strong communication skills and understanding of incident medication error tracking.
• Knowledge of HIPAA, infection control, and nursing best practices.

1. Conduct audits of Medication Administration Records (MARs) for accuracy and completeness.
2. Review and evaluate nursing notes for clinical clarity, compliance, and timeliness.
3. Audit daily vitals logs and flag abnormal or missing data for clinical review.
4. Ensure physician orders and medication changes are documented and transcribed properly.
5. Monitor and track medication errors, omissions, and incidents with follow-up plans.
6. Collaborate with facility nurses and nursing supervisors to resolve compliance issues.
7. Verify documentation of PRNs and follow-up response is complete and appropriate.
8. Ensure lab orders and results are reviewed, documented, and communicated timely.
9. Participate in mock audits and payer review preparation for nursing compliance readiness.
10. Report monthly trends in nursing documentation to the Compliance Director and facility leadership.

• Associate's or Bachelor's degree in Nursing
• 2+ years of experience in the behavioral health or residential nursing roles
• RN licensure in the State of Georgia

• Paid time off
• Paid Holidays
• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• Team-oriented work environment

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• Manage medical records requests, ensuring security, timeliness, and adherence to privacy regulations.
• Coordinate provider approvals and maintain documentation logs.
• Serve as a liaison to patients, legal representatives, payors, and regulatory agencies.
• Recommend improvements to streamline medical records workflows and ensure accuracy.
• Assist with audits, compliance training, internal investigations, and policy updates.
• Track compliance activities and escalate issues to the Compliance Officer as needed.
• Support compliance committees, including scheduling, agenda creation, and minute-taking.

• Provide direct supervision to support staff assisting with medical records or compliance-related duties.
• Ensure clear delegation, training, and performance tracking for assigned team members.

• Maintain strict confidentiality and ensure data security protocols are followed at all times.
• Collaborate with internal departments to align processes with regulatory standards.
• Perform additional duties as assigned to support department and organizational needs.

• Required: High school diploma or equivalent
• Preferred: Bachelor's degree in healthcare administration, Health Information Management, or related field
• 2-3 years of experience in medical records, compliance, HIM, or a similar field
• Working knowledge of HIPAA, privacy laws, and healthcare compliance practices
• Strong communication, problem-solving, and organizational skills
• Excellent attention to detail and ability to manage confidential information
• Proficiency in Microsoft Office Suite and Electronic Medical Records (EMR) systems
• Valid Arizona Fingerprint Clearance Card, or ability to obtain prior to hire.

• Comprehensive low-cost medical, dental, and vision insurance.
• Generous retirement plan with a 3.5% company match.
• Secure your future with both long and short-term disability options
• Enjoy holiday pay, PTO, and life insurance benefits.
• Protect your future with long and short-term disability options.
• We offer an employee wellness program and fantastic discounts for all Denova team members.
• And there's so much more waiting for you!

Job Description

The Medical Policy & Compliance Specialist is responsible for researching, analyzing, and interpreting CMS (Medicare) and state Medicaid guidelines to ensure the organization's processes and procedures adhere to established rules and evolving legislation. This role serves as an internal subject matter expert on healthcare payer policies to develop and update billing procedures, assist with provider inquiries, identify compliance risks areas, and support process improvement initiatives across the company. 

Salary: $110,000/Annually 

The Medical Policy & Compliance Specialist responsibilities include but are not limited to:
 

• Deep knowledge of CMS, state Medicaid, and NCQA regulations relevant to Utilization Management (UM), Credentialing and Claims, with the ability to translated them into operational requirements
• Strong understanding of DME billing guidelines, medical necessity criteria, coding protocols (ICD-10, HCPCS, modifiers, non-covered codes) from an operational compliance and policy perspective
• Ability to proactively monitor regulatory changes, assess downstream operational impacts, and recommend timely updates to policies and procedures
• Skilled in audit preparation and mock reviews to ensure readiness for NCQA, CMS, Medicaid and external health plan audits
• Strong analytical and problem-solving skills with the ability to spot compliance risk and propose actionable solutions
• Excellent written and verbal communication skills and ability to explain complex regulatory requirements in clear, practical terms to staff and leadership
• High organized and detail oriented with the ability to manage multiple priorities independently in a lean team environment
• Comfortable functioning as the primary operational compliance resource while collaborating effectively with UM, Credentialing, Claims, Business Intelligence and other teams
• Proficiency in Microsoft Office applications, specifically intermediate Excel or equivalent data analysis skills preferred

• Minimum 3 years experience in healthcare compliance, regulatory affairs, and/or utilization management within a health plan or managed care environment
• Demonstrated expertise in CMS and state Medicaid regulations with the ability to translate policy into operational requirements for UM, Cred and Claims
• Proven ability to proactively monitor, analyze, and respond to regulatory changes, including developing policy/procedure updates and staff guidance
• Strong collaboration with cross functional teams to resolve operational compliance issues and strengthen processes
• Experience working independently in small or lean team environment, balancing multiple priorities and serving as the primary operational compliance resource
• Excellent analytical, problem solving, and written/verbal communication skills, intermediate Excel and data analysis skills are preferred

• Become self sufficient in the UM system and core UM, Credentialing and Claims workflows
• Stand up a regulatory monitoring cadence (CMS updates, state Medicaid portals, NCQA updates, etc.) to track changes impacting operations
• Begin delivering compliance summaries and recommendations to leadership and frontline teams  Conduct initial mock audits checks again UM and Cred process to identify baseline gaps and risk
• Build relationships with UM, Credentialing, Claims, & Business Intelligence teams to establish yourself as the go to operational compliance resource
• Support early implementation activities by reviewing requirements and flagging regulatory considerations before go live

• Demonstrate subject matter expertise in CMS and state Medicaid guidelines, including their operational impact on UM and Credentialing
• Expand working knowledge of ICD-10, HCPCS, and DME billing protocols to interpret regulatory requirements (not day to day coding)
• Establish a structured process to proactively monitor CMS, state Medicaid, and regulatory updates that impact UM, Credentialing and Claims operations
• Support preparation for external audits by conducting mock reviews and ensure required compliance documentation is in place
• Identify process improvement opportunities that reduce compliance risk or improve regulatory alignment
• Actively support new client implementations by ensuring operational workflows and policies are aligned with payer and accreditation requirements from the outset
• Maintain expected timelines while demonstrating the ability to anticipate and respond quickly to new or revised regulations

Benefits Offered

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance
• Company-paid short term disability coverage (location restrictions may apply)
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO)
• Paid Parental Leave
• Sick Time
• Paid company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities

Remote Opportunities

We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.

Our Story

Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health.

With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.

Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.

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• Bachelors Degree
• CRCM and/or CAMS preferred
• 7 to 10 years experience in banking with 3 to 5 years of compliance experience
• Strong computer skills: Advanced skill level in Microsoft Excel; Experience with Microsoft Word and PowerPoint. Experience with industry-related systems/software
• Strong data analysis skills
• Knowledgeable of compliance laws, rules, and regulations including consumer protection regulations, TRID-RESPA, UDAAP, FCRA, HMDA, etc. Thorough knowledge of the Bank Secrecy Act, CRA, and any other regulations is required.

• The Compliance Officer is responsible for maintaining current knowledge of BSA, AML, and OFAC regulations and all bank-related compliance regulations. This person will also use monitoring application systems, maintain investigation files, and conduct periodic assessments of the departments for compliance. Prepare BSA/AML Risk Assessment by identifying the risk profile of the Bank and analyzing the information to better assess the risks identified and mitigate any gaps in control
• Oversee the preparation, research, and filing of SARs and CTRs
• This position will serve on the Compliance Committee and the IT Steering Committee
• Assign and monitor annual BSA training and all other compliance training to Board and Employees
• Meet and discuss with Examiners and Auditors regarding the BSA program and compliance
• Review all projects for BSA and compliance-related issues
• Responsible for monitoring the effectiveness of the Identity Theft Program and providing updates to the Board of Directors
• This position is responsible for monitoring all bank regulations and creating/changing policies and/or procedures for new or updated regulations
• Will be responsible for monitoring/changes of all disclosures for compliance with Federal and State regulations. Reviews product and service disclosures and advertising materials for compliance with applicable rules
• Conduct due diligence on new MSB applications, and establish and direct ongoing monitoring activities for those MSBs based upon risk

JCW is currently partnering with a Credit Union in Boston who is looking to bring on a new Compliance & Risk Officer to their team. This role would be reporting directly to the Credit Union's CEO.

Job Responsibilities

• Develop and maintain the Compliance program for the Credit Union.
• Identify and mitigate potential operational and reputational risks.
• Monitor any relevant regulatory changes that may impact the Credit Union.
• Provide Compliance trainings to Credit Union employees.

Job Requirements

• 5+ years of Compliance and Risk experience.
• Professional certifications like CUCE and CRCM preferred.
• Prior experience with Credit Unions or Banking.

• Bachelors Degree
• CRCM and/or CAMS preferred
• 7 to 10 years experience in banking with 3 to 5 years of compliance experience
• Strong computer skills: Advanced skill level in Microsoft Excel; Experience with Microsoft Word and PowerPoint. Experience with industry-related systems/software
• Strong data analysis skills
• Knowledgeable of compliance laws, rules, and regulations including consumer protection regulations, TRID-RESPA, UDAAP, FCRA, HMDA, etc. Thorough knowledge of the Bank Secrecy Act, CRA, and any other regulations is required.

• The Compliance Officer is responsible for maintaining current knowledge of BSA, AML, and OFAC regulations and all bank-related compliance regulations. This person will also use monitoring application systems, maintain investigation files, and conduct periodic assessments of the departments for compliance. Prepare BSA/AML Risk Assessment by identifying the risk profile of the Bank and analyzing the information to better assess the risks identified and mitigate any gaps in control
• Oversee the preparation, research, and filing of SARs and CTRs
• This position will serve on the Compliance Committee and the IT Steering Committee
• Assign and monitor annual BSA training and all other compliance training to Board and Employees
• Meet and discuss with Examiners and Auditors regarding the BSA program and compliance
• Review all projects for BSA and compliance-related issues
• Responsible for monitoring the effectiveness of the Identity Theft Program and providing updates to the Board of Directors
• This position is responsible for monitoring all bank regulations and creating/changing policies and/or procedures for new or updated regulations
• Will be responsible for monitoring/changes of all disclosures for compliance with Federal and State regulations. Reviews product and service disclosures and advertising materials for compliance with applicable rules
• Conduct due diligence on new MSB applications, and establish and direct ongoing monitoring activities for those MSBs based upon risk

• Generous Paid Time Off Package. (Full-time employees can earn 22 days of vacation, 9 days of sick time by the end of the first year). Accrual increases with length of service.
• Medical and Dental Coverage (begins 1st of the month following hire date)
• VSP Vision Coverage (begins 1st of the month following hire date)
• 403(B) Retirement Savings (Pre- and post-tax plans with matching contribution)
• Flexible Spending Account (FSA) (Medical, dependent care, and transportation options)
• Long-Term Disability, and Life Insurance
• Paid Bereavement and Jury Duty Leave
• Length of Service Award, Outstanding Employee of the Department Annual Award
• Voluntary Life Insurance
• Accidental Coverage Insurance
• Student Loan Forgiveness Program (PSLF), NHSC Loan Repayment Program
• Educational Assistance (up to 5,250 a year), Professional Development Assistance
• Licensure Supervision and Continued Education Provided

• Employee Assistance Program's (EAP)
• Trauma Support Team - Monthly Loss Processing Group led by our Licensed Clinical Directors

• Develop and maintain the annual compliance plan. Oversee the implementation and management of compliance plan activities.
• Create a comprehensive fraud waste and abuse (FWA) prevention program and oversee the functions of the FWA program.
• Monitor and respond to the agency compliance hotline
• Monitor federal, state, and industry specific laws and regulations for obedience. When updates are made to any such regulations, informing necessary stakeholders and leadership within the agency.
• Report to the Board of Directors, regulatory audit and oversight committee, and other board committee(s) regularly and as directed.
• Develop, implement, and maintain CCMH's policies and procedures system necessary to comply with legal and regulatory requirements and consistent to internal standards.
• Oversee all internal auditing and monitoring activities including at minimum service delivery documentation, policy and procedure, program staffing, and quality metric goals.
• Investigate and respond to any report of non-compliance made by an employee, supervisor, director, or external entity.
• Developing and maintaining a quality assurance process improvement (QAPI) committee, for the purpose of ensuring the annual quality assurance and quality improvement plan and overseeing the completion of quality improvement projects.
• Coordination with members of senior leadership regarding the compliance of current systems operations, required changes needed to maintain industry compliance, and communications.
• Monitor and maintain effective language for CCMH proprietary materials including as example(s) consent to treatment, notice of privacy practices, code of conduct, business associate agreements, etc.
• Coordinating with governing entities as it relates to external auditing and evaluation of program performance.
• Facilitate preparation and responses to site reviews as it relates to implementing preventative on-site reviews, creating/responding to plan-of-corrections, and reporting/ communicating to the governing entity.
• Maintaining an effective whistleblower protection program.
• Reporting any discrepancy in performance to a legal or regulatory requirement as obligated by the compliance plan.
• Oversee ethical reporting of any and all instances of non-compliance with a federal, state, or industry specific regulatory requirement.
• Manage and coordinate effective compliant investigation and response from clients, community partners, employees, etc.
• Educate employees on applicable federal, state, and industry specific laws and regulations.
• Organize the content and structure of specific industry training as it relates to critical areas of employment responsibilities.
• Other duties as assigned.

• Must have the ability to assist the team in providing safety to all clients and staff in potentially volatile situations.
• Occasionally stooping, lifting (20-50 lbs.), climbing (stairs), crouching, reading, and running
• Regularly sitting, walking, standing, and keyboarding

Are you a hands-on leader who thrives on being apart of a team and creating an exceptional customer experience? Were looking for a Compliance Officer to join our accounting teamwho's strengths are in accounting and audits and working with the staff to ensure compliance. RELOCATION TO CRIPPLE CREEK, CO.

• Training staff on compliance and internal controls adhering to state regulation.
• Conduct internal audits as well as participated in state audits.
• Analyze repots, identify opportunities, and implement strategies.
• Create an outstanding customer experience at every touchpoint.

• 4+ years of experience in casino gaming audit and accounting.
• A proven leader with a collaborative, motivational style and a growth mindset.
• Strong background in accounting, compliance and regulation.
• Expertise in state and federal gaming laws, audits and training.
• Excellent communication and problem-solving skills.

• Competitive base salary plus relocation.
• Comprehensive benefits package: medical, dental, vision (starting at 90 days).
• Ongoing leadership development and clear paths for career advancement.

Apply today and take the next step in your leadership career!