Compliance Specialist Nurse (Delegation Oversight RN) Job at The Judge Group, Philadelphia, PA

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  • The Judge Group
  • Philadelphia, PA

Job Description

Job Title: Compliance Specialist Nurse (Delegation Oversight RN)

Location: Hybrid – Onsite Tuesday to Thursday, Remote Monday & Friday

Employment Type: Contract (Temp-to-Perm Potential)

Schedule: Monday–Friday, 8:45 AM – 4:30 PM

Job Summary:

We are seeking a Compliance Specialist Nurse (RN) to oversee delegated vendor activities (UM, CM, Appeals) and ensure compliance with regulatory and accreditation standards including NCQA and Medicare Part C & D. This role involves auditing, reporting, and presenting findings to the Delegation Oversight Committee.

Key Responsibilities:

  • Conduct pre-delegation assessments and ongoing audits of vendor activities
  • Prepare audit reports and present findings to oversight committees
  • Develop and track corrective action plans (CAPs)
  • Ensure compliance with reporting requirements
  • Maintain documentation for delegation readiness and compliance

Qualifications:

  • Active RN license in Pennsylvania (compact licenses not accepted)
  • Minimum 3 years of experience in compliance, accreditation, or regulatory roles within healthcare or managed care
  • Strong knowledge of NCQA, Medicare Part C & D, ACA, and QHP requirements
  • Proficiency in Microsoft Office Suite, especially Excel
  • Experience with Governance Risk Compliance (GRC) tools
  • Excellent communication and presentation skills
  • High attention to detail and ability to manage multiple priorities

Interview Process:

One virtual interview round leading to an offer.

Job Tags

Permanent employment, Temporary work, Work at office, Remote work, Monday to Friday,

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