Remote Utilization Review Rn Jobs in Quincy, MA (NOW HIRING)

Vitra Health is a mission-driven healthcare organization committed to improving the quality of life for individuals and families across Massachusetts. Through innovative home- and community-based services, Vitra supports aging adults, people with disabilities, and individuals with complex care needs- supported by a Nurse, and Case Manager, Vitra ensures clients receive compassionate, personalized, and dignified care.

To help share our mission and expand our community impact, Vitra Health is seeking a Clinical Compliance Manager who is passionate about community engagement and helping people access the care and resources they deserve.

As a Clinical Compliance Manager, you will play a critical leadership role within the Compliance Department, overseeing day-to-day compliance in healthcare delivery operations, while also driving strategic initiatives based on audit reviews to strengthen regulatory adherence, audit readiness, and quality performance.

You will be responsible for compliance monitoring activities across Vitra Health's Adult Foster Care (AFC), Group Adult Foster Care (GAFC), and ADH programs, ensuring accurate documentation, risk mitigation, and alignment with state and federal regulatory requirements.

This role requires a strong clinical background (RN required), deep knowledge of healthcare regulatory and accreditation compliance, and the ability to lead cross-functional initiatives across clinical operations, field staff, and leadership teams. You will serve as a key decision-maker for compliance escalations and corrective action planning.

Key Responsibilities

Compliance Program Leadership & Management

• Lead execution of the organization's compliance program and annual compliance workplan in partnership with Compliance leadership
• Manage day-to-day compliance in healthcare delivery's operations, monitoring activities, and audit readiness initiatives
• Oversee implementation of policies, procedures, and internal controls in alignment with regulatory and accreditation requirements
• Monitor federal and state regulatory updates, and accreditation updates, and lead operational implementation of required changes
• Manage compliance tracking systems, dashboards, audit logs, and reporting processes
• Serve as a primary point of contact for internal and external audits, regulatory surveys, and payer inquiries
• Prepare and present compliance reports and findings to senior leadership and regulatory bodies

Monitoring, Risk Management & Quality Oversight

• Lead risk-based compliance monitoring across clinical documentation and service delivery functions
• Identify systemic compliance risks across AFC, GAFC, and ADH programs and drive corrective action strategies
• Oversee medical record and claims review processes to ensure regulatory accuracy and billing integrity
• Conduct and supervise onsite and remote audits of field operations, caregiver performance, and documentation quality
• Ensure appropriate classification, escalation, and resolution of compliance issues based on risk level
• Lead root cause analysis and development of corrective and preventive action (CAPA) plans
• Monitor effectiveness of remediation efforts and ensure sustained compliance improvement
• Ensure alignment of care team documentation with regulatory and program requirements
• Provide oversight and guidance on caregiver education and compliance training effectiveness
• Partner with leadership to implement risk mitigation strategies across operations
• Fosters a culture of customer service and commitment to quality care
• Serves as a brand ambassador for Vitra reflecting our vision, mission, and values
• Shows a genuine interest and compassion for the communities we serve and commitment to the diversity of our clients and team members
• Mentor and supports team members
• Complete other tasks as assigned

Training, Leadership & Cross-Functional Collaboration

• Lead compliance training programs for field staff, care teams, and operational leaders
• Oversee onboarding and ongoing education related to compliance, documentation, and regulatory standards
• Act as compliance liaison to operations, clinical leadership, quality, and audit teams
• Provide coaching and oversight to compliance staff and field auditors as applicable
• Drive a culture of accountability, continuous improvement, and regulatory excellence
• Serve as a key escalation point for compliance issues requiring leadership intervention
• Represent Vitra Health as a compliance leader and brand ambassador across internal and external engagements

What we are looking for:

• Active Registered Nurse (RN) license in Massachusetts required
• Bachelor's degree in Nursing required (BSN or Master's strongly preferred)
• 5-7+ years of progressive experience in healthcare compliance, regulatory affairs, accreditation surveys, clinical auditing, or quality assurance
• Prior leadership or supervisory experience strongly preferred
• Strong experience with Medicare/Medicaid-funded programs (AFC, GAFC, ADH strongly preferred)
• Certifications preferred or willingness to obtain within 6-12 months:
• CHC (Certified in Healthcare Compliance)
• CPC or CCS
• Strong knowledge of HIPAA, CMS regulations, OIG guidance, and healthcare compliance frameworks
• Proven experience leading audits, investigations, and compliance programs
• Strong analytical, leadership, and risk management capabilities
• Advanced proficiency in Microsoft Excel and PowerPoint
• Experience with EMR systems, compliance tracking tools, or risk management platforms
• Ability to lead cross-functional initiatives and influence at all organizational levels
• Willingness to travel between office and field locations as needed

Work Environment and Physical Requirements

• Office-based work in a clean well-lit environment with fluctuating temperatures near others.
• Client-facing field staff and community liaisons require frequent travel to client homes or community settings; ability to drive safely; work in client homes may involve varying temperatures, odors, allergens, pets, and other environmental factors.
• Requires substantial periods of repetitive work utilizing a computer, monitor, keyboard, and mouse.
• Requires lifting and carrying equipment and supplies weighing up to 35 pounds; requires pushing and pulling equipment and supplies weighing up to 35 pounds; requires walking and standing; requires frequent sitting more than 75% of the workday; requires the ability to negotiate stairs; requires visual acuity and manual dexterity to operate equipment.

Perks and Benefits:

• Employer sponsored health Insurance with a generous employer match.
• Dental and Vision Benefits.
• Supplemental Benefits
  • Life, Accident, Critical Illness and Disability Insurance.
• 401K with a 5% company match.
• Accrued Paid-Time-Off.
• Ten company paid holidays.
• Wellness Benefits.
• Tuition Reimbursement.
• Supportive team structure and company culture with a focus on work/life balance.

Vitra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.