Remote Utilization Review Rn Jobs in Sterling Heights, MI

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place.

Job Description:

Senior Compliance Auditor - RN (Remote)

At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there's no place like home, and that's why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their journey of health, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Senior Compliance Auditor. Being a part of something this great starts by carrying out our mission every day through your true calling: developing an amazing team of compassionate and dedicated healthcare providers.

To continue to be an industry pioneer in delivering unparalleled care, we need a Senior Compliance Auditor with commitment and compassion. Are you one of them? If so, apply today!

Why Join the Elara Caring mission?

• Work in a collaborative environment.
• Be rewarded with a unique opportunity to make a difference
• Competitive compensation package
• Tuition reimbursement for full-time staffand continuing education opportunities for all employees at no cost
• Opportunities for advancement
• Comprehensive insurance plans for medical, dental, and vision benefits
• 401(K) with employer match
• Paid time off, paid holidays, family, and pet bereavement
• Pet insurance

As a Senior Compliance Auditor you'll contribute to our success in the following ways:

• Displays readiness to participate in all comprehensive or stratified audits related to skilled home health, hospice, palliative care, personal care services ("PCS") and behavioral health.
• Audits for trends related to billing compliance and delivers education to agency leaders based on those trends.
• Provides recommendations and positive feedback to the Billing Compliance Audit team.
• Prepares written audit results for reporting to agency leaders following finalization of audit findings.
• Provide secondary review/oversight of PCS policy development, revisions and reviews for new and existing providers and programs.
• Assists in the development of all compliance and quality education as well as updates to compliance resource manuals, policies, standard operating procedures, and tools.
• Provides secondary review / oversight to ensure audits are accurate prior to finalization and auditors understand and adhere to billing rules in conducting audits, when needed.
• Monitors trends among audit deficiencies, recommends and develops broad-based training to assist in remediating identified issues.
• Collaborates with clinicians, managers, account executives, intake coordinators, directors, and administrative staff to facilitate compliance with all pertinent regulatory requirements.
• Serves as a resource to clinicians, Clinical Managers and others regarding coding, documentation, OASIS guidelines, and related CMS questions and concerns.
• Collaborates with other members of the Compliance Department to ensure alignment and visibility across functional compliance areas.
• Maintains patient and staff privacy and confidentiality pursuant to HIPAA Privacy Final Rule.
• Maintains current knowledge of applicable payment regulations, federal and state laws and accreditation standards and promotes compliance with all accreditation, federal, state, and local regulations.

• Escalates and reports serious compliance, billing, or other business risks timely to the Director of Compliance Audit and Governmental Review and other functional leadership by demonstrating the ability to exercise good independent judgment in assessing the significance and relevance of identified issues.
• Assists in ensuring audit programs are focused on prevention, timely reporting, and timely remediation.
• Facilitates partnerships with operational leaders to ensure they address key compliance initiatives and in the development of action plans based on identified risks.
• Attends audit findings calls, as needed, and assists in the development of corrective action plans, ensuring implementation of corrective actions in a timely fashion including corrective actions relating to internal compliance reviews, oversight audits and regulatory audits..

What is Required?

• Associate or Bachelor of Science in Nursing.
• A minimum of five (5) years' experience in Corporate Compliance healthcare coding/billing audit is required.
• A minimum of two (2) years of demonstrated leadership ability required.
• Certified Homecare Coding Specialist (HCS-D),
• Certified OASIS Specialist-Clinical (COS-C), or willingness to obtain within one (1) year
• Registered Nurse along with home health and hospice coding experience is required.
• Minimal Travel Required.
• Meets all applicable agency policies and procedures related to health screening and required testing.

You will report to the Compliance Audit Manager

The base salary for this position is$80,000-$90,000 annually and is based on the company's good faith estimate at the time of posting. Actual pay will be determined based on factors such as education, experience, skills, and internal equity.

Equal Employment Opportunity: We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic. If you require assistance due to a disability in the application or recruitment process, please submit a request via email at recruiting@elara.com.

Pay & Benefit Information: Compensation for this role will be determined based on a variety of factors, including qualifications, skills, competencies, and relevant experience. Elara offers a broad range of benefits. Learn more at https://careers.elara.com/us/en/benefits

EVerify: Elara Caring participates in E-Verify after a job offer is accepted and Form I-9 completed.