Clinical Compliance Program Manager

WellSky (formerly Mediware and Kinnser Software) delivers software and services to transform an ever-growing range of care services worldwide. We anticipate the needs of care providers and communities, empowering them with insights and solutions, so both businesses and communities flourish. Building on a history of excellence and a reputation for quality, WellSky enables providers to deliver exceptional care, improve operational efficiency, reduce cost, and meet the challenges of their rapidly changing industries.

This job is responsible for ensuring compliance with WellSky's Utilization Management and Compliance Program by serving as a clinical expert on state and federal regulations. The scope of this job includes analyzing and presenting data to establish best practices across post-acute health care settings, including LTACHs, IRFs, SNFs, and Home Health facilities. We invite you to apply today and join us in shaping the future of healthcare!

Facilitate activities related to performance measurement and outcomes, ensure the organization meets CMS, NCQA, and other regulatory standards, stay updated on relevant regulatory changes, and support their integration into practices. Comply with state, federal, and organizational standards by assisting in the development and enforcement of policies aligned with Utilization Management and Compliance requirements. Develop and guide the implementation of internal audit protocols in compliance with CMS regulations and NCQA standards and contribute to the consistency of clinical documentation and decision-making processes. Analyze data to identify trends and areas for improvement, and execute defined projects aimed at enhancing care quality across various lines of business. Generate and validate reports to monitor performance and compliance across health plan contracts, ensuring accuracy and alignment with requirements. Prepare for regulatory, accreditation, and contractual audits, and contribute to the remediation and documentation of audit findings. Perform other job duties as assigned.