Carex is partnering with a leading Life Sciences industry partner to identify a Clinical Integrity and Compliance Consultant. This regional role will support the development and implementation of clinical quality improvement initiatives designed to strengthen clinical services, compliance, and patient care. This role will collaborate with clinical, operational, legal, compliance, and business stakeholders to promote consistent practices and processes across care settings.
Summary
The Manager, Clinical Integrity and Compliance will assist in managing clinical integrity and compliance operations, including regulatory inquiries, quality-of-care investigations, clinical policies and procedures, and provider education. This individual will help ensure clinical practices align with applicable state and federal regulations, accreditation standards, and organizational requirements.
Contract Duration: 6mo, covering an employee leave
Location: Remote
Compensation: $40-47/hr
What You'll Do
- Manage daily inquiries related to clinical integrity and compliance.
- Support the development, implementation, and management of workflows that strengthen clinical integrity and compliance operations.
- Provide guidance and support on compliance-related matters, including documentation standards and ethical considerations.
- Conduct discovery and provide recommendations regarding clinical compliance issues involving state and federal rules and regulations, including state-specific scope of practice and prescriptive authority requirements for various clinician types.
- Conduct discovery and collaborate cross-functionally on critical incidents and quality-of-care investigations, providing formal conclusions and recommendations.
- Support internal departments and external agencies by responding to board inquiries, payer audit requests, regulatory inspections, and interviews.
- Collaborate with Legal and Compliance teams and clinicians during board complaint investigations.
- Assist with identifying, developing, and managing clinical policies, procedures, and guidelines aligned with accreditation standards such as URAC, Joint Commission, and NCQA.
- Assist with developing and delivering education and training related to clinical compliance concerns.
- Participate in committees related to clinical compliance as assigned.
- Support APP supervisory programs.
- Support therapy supervision protocols.
What You'll Bring
- Master's or doctoral degree in Psychology, Social Work, Counseling, Nursing, or a related field.
- 2+ years of clinical practice experience.
- 2+ years of experience developing and implementing clinical integrity and regulatory policies and procedures.
- 2+ years of experience providing clinical supervision and training to providers within the applicable discipline, such as LCSWs, LPCs, LMFTs, or APPs, preferred.
- Prior experience with a regulatory compliance program within a healthcare delivery or payer organization preferred.
- Demonstrated awareness, inclusivity, sensitivity, humility, and experience working with individuals from diverse ethnic backgrounds, socioeconomic statuses, sexual orientations, gender identities, and other aspects of culture.
- Legally authorized to be employed in the United States.
- Ability to meet the physical requirements of the role, with reasonable accommodations available for individuals with disabilities.
Carex Consulting Group is an equal opportunity employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, marital status, disability, gender identity, or Veteran status.
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