Regulatory Compliance Specialist

Scope of Work Assists with management of compliance and/or accreditation standards, laws, rules and regulations related to the clinical environment. Supports the resolution of compliance and/or accreditation investigations in the clinical environment and follows up with various parties to assure complete resolution. Supports the management and administration of the Compliance and/or Accreditation Plan(s). Identifies root causes and assures plans and standards are in place including development, education and implementation of related procedures and policies in the clinical environment. Maintains thorough knowledge of compliance and/or accreditation policies, procedures, issues, and trends. Essential Functions Supports audits and investigations of compliance and/or accreditation concerns related to the clinical environment; performs necessary research, documents findings, and follows up with applicable parties through complete resolution. Collects, collates, monitors and audits data and activities in the clinical environment to assure accuracy and to prevent, detect and correct non‑compliance, illegal activities, and potential or actual fraud, waste or abuse. Supports regulatory surveyor site visits including preparation and corrective action response. From time to time, performs investigations at the direction of legal counsel and works with legal counsel in the course of such investigation to provide guidance, recommendations and other assistance as requested by legal counsel. In such cases, the employee will report directly to legal counsel as opposed to employee’s up‑line leadership, and such work with legal counsel shall be confidential and protected from disclosure by the attorney client privilege and work product protection. Exercises administrative judgment and assumes responsibility for decisions, consequences and results having an impact on people, costs, and quality of service. Assists with the development, implementation and maintenance of process improvement including departmental and/or organizational policies, procedures and methodologies and medical record design - assuring compliance with laws, regulations and standards while using accumulated data. Reviews and monitors adherence to documented plans and programs including the Code of Excellence. Assists in the review of clinical regulatory standards, evaluation of the level of compliance, identification of challenges, proposal of solutions, monitoring of compliance and management of evidence documents. Assists with continuous readiness activities. Collaborates with operational and other areas in investigations and to implement ongoing risk identification and mitigation measures related to the clinical environment. Proactively consults with operational areas and leadership through both formal (meetings, education) and informal means. Maintains knowledge of laws, regulations and standards impacting healthcare delivery and reimbursement. Applies laws, regulations and standards in daily situations while educating others through various means including formal training and education. Performs or supports related assessments to assure compliance to laws, regulations, standards and policies and procedures. Assists in a variety of projects related to compliance and accreditation related to the clinical environment. Identifies best practices and research and evaluates its implementation within our organization. Assists in the development of recommendations and action plans. Maintains attention to detail, documents details appropriately, and effectively articulates recommendations and outcomes both verbally and in writing in both small and large group forums. Qualifications Required Bachelor's Degree or equivalent in business, health care operations, nursing or other related area, or equivalent combination of education and experience LIC‑Registered Nurse (RN) State of Michigan 2 years of related experience Preferred Working in an organization of size and complexity of Corewell Health CRT‑Healthcare Compliance, Certified (CHC) - HCCA Health Care Compliance Association Benefits Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here. On‑demand pay program powered by Payactiv Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! Optional identity theft protection, home and auto insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status Primary Location : SITE - Corewell Health Place - 100 Corewell Drive NW - Grand Rapids Department Name : System Compliance - Corporate Employment Type : Full time Shift : Day (United States of America) Weekly Scheduled Hours : 40 Hours of Work : 8 a.m. - 5 p.m. Days Worked : Monday to Friday Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. #J-18808-Ljbffr