RN Clinical Regulatory Specialist

Compliance And Accreditation SpecialistAbout Corewell HealthOur new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value. Through compassion, collaboration, clarity, curiosity and courage, we make anything and everything possible. Through our people, we care for the whole person with respect, dignity and love. Everyone deserves opportunities and resources for better health. Everyone deserves our relentless pursuit to innovate and always do better. Everyone deserves to have a community be a great place to live, work, learn and play. We believe health and well-being should be within reach for all. We believe the system to support the entire health and wellness journey starts with prevention. We believe that together we will make a difference. Together, we are here to make health better for everyone. Together, we are Corewell Health.Scope of WorkAssists 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 FunctionsSupports 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.QualificationsRequiredBachelor's Degree or equivalent in business, health care operations, nursing or other related area, or equivalent combination of education and experienceLIC-Registered Nurse (RN) State of Michigan2 years of related experienceClinical BackgroundPreferredWorking in an organization of size and complexity of Corewell HealthCRT-Healthcare Compliance, Certified (CHC) - HCCA Health Care Compliance Association