National Clinical Compliance Auditor

About UsA pioneer in the caregiving space, Careforth supports family caregivers across the United States to confidently care for their loved ones at home. Through a combination of in-person home visits, remote coaching and our proprietary digital collaboration app, we provide caregivers with support, guidance, confidence, and connection to resources they need. The Caregivers and families we support stay with Careforth for many years, building lasting relationships along the way. Join us today and live our values: lead with heart, cultivate trust, go beyond.Position SummaryUnder the direct supervision of the Sr. Director, Clinical Programs & Operations, the National Clinical Compliance Auditor is responsible for planning and conducting operational, compliance, and regulatory audits in support of the Corporate Compliance Plan and other clinical and compliance initiatives. The National Clinical Compliance Auditor interacts with internal stakeholders as well as external auditors when applicable. What You Will Do• Review and stay informed on relevant laws, regulatory requirements, clinical protocols, contractual obligations, and accreditation standards to effectively monitor and ensure compliance• Coordinate and conduct annual internal audits in accordance with the company’s Auditing and Monitoring Policy, including operational and clinical audits as needed.• Support successful external audits with regulatory and accrediting entities; review documentation that will be submitted in response to external audits and identify risk areas to the Chief Compliance Officer. • Through auditing practices and documentation review, identify potential compliance inquiries and escalate issues as appropriate• Conduct focused audits, as assigned• Prepare detailed audit reports, summarizing findings and recommending corrective actions, present results to compliance and quality improvement committees• Provide guidance to Operations leadership in the development, implementation and monitoring of a Corrective Action Plan (CAP) in response to internal and external surveys• Maintain accurate and organized documentation of audit processes and outcomes• Develop and revise audit tools, clinical policies and procedures to ensure alignment with regulatory or contract requirements• Monitor, trend, and analyze audit results, assist with root cause analysis and suggest recommendations for process changes as identified.• Provide information from audits to those responsible for developing staff educational programs. Develop and deliver training, as needed. • Assist in the development and implementation of strategies to improve outcomes. • Review and coordinate delivery of records in response to requests for clinical or financial records from external requestors. What You Will Bring• Bachelor’s degree in nursing, minimum of 5 years of direct clinical experience working with elders or individuals with disabilities• RN license required• Comprehensive knowledge of Medicare, Medicaid, managed care billing practices, service agreements, and general knowledge about the healthcare delivery model• Thorough understanding of risk and compliance management programs including methods to design, measure, implement, and improve a variety of business compliance areas.• Strong analytical and organizational skills, ability to successfully plan, organize and manage audit projects, including delivery of audit reports and findings and the oversight of corrective action plan development and monitoring through to completion• Proficiency with Microsoft Office (e.g. PowerPoint, Word, and Excel) and medical documentation systems is required; Salesforce experience is a plus• Strong written and verbal communication skills; excellent interpersonal skills and ability to develop strong working relationships with cross-functional teamsYou'll Benefit FromAt Careforth your well-being matters.With flexible schedules, a remote-first culture, and a nationally recognized wellness program, our benefits are designed to help you thrive, both professionally and personally. Discover how we invest in you:The pay range for this position is $66,514 - $93,121. The actual wage offered may be lower or higher depending on budget and candidate experience, knowledge, skills, qualifications, and geographic location. JoinOur Award Winning TeamFounded in Boston, Careforth's caregiver programs and services improve health outcomes, keeping care at home longer.Additionally, our programs provide financial benefit to caregivers and cost savings to state agencies and health plans. At Careforth, we understand the challenges of caregiving and are committed to supporting family caregivers at every turn. Caregivers play a critical role in the future of healthcare—and so can you. For more information, please visit www.Careforth.com. Careforth is an Equal Opportunity Employer* DISCLAIMER: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.• Careforth supports families with diverse backgrounds and as an equal opportunity employer, we seek employees who reflect the diverse population we serve. Careforth complies with all applicable laws concerning hiring and employment practices and is firmly committed to fostering and maintaining a workplace free from discrimination. We pledge to hire, train, and promote our employees without regard to race, religion, gender, gender identity, genetic information, age, national origin, sexual orientation, disability, veteran status, or any other category protected by applicable law.Careforth strives to create experiences that are accessible and welcoming to everyone, including making www.careforth.com and the careers site accessible to any and all users. If you would like to contact us regarding the company’s diversity, equity and inclusion initiatives, inquire about a specific accessibility need or the accessibility of our website, or if you need assistance completing an application process, please contact People & Culture at 866-797-2333. Apply tot his job