RN, Clinical Compliance Specialist

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

How will this role have an impact? Signify Health formed internal clinical compliance team and is excited for this role to help develop clinical quality and compliance and ensure our members receive the best possible care. The RN Clinical Compliance Specialist will assist the team with maintaining policies and processes related to clinical compliance. This role will be responsible for daily operations of the Signify HCS clinical compliance program, as well as any ad hoc regulatory research and analysis as needed. This role will also be responsible for conducting, monitoring, and investigating functions related to clinical compliance driven by member compliance, compliance concerns and member amendment requests. This role will report to our Manager, Clinical Compliance.

Conduct audits, including collecting, monitoring and analyzing data. Lead clinical compliance investigations, which will require respectful and confidential investigative techniques. Apply clinical knowledge to gather, collate, and interpret data findings and appropriate next steps. Communicate effectively the findings of confidential investigations to appropriate leadership. Support and maintain clinical compliance policies, procedures and processes at direction of manager and or leadership. Collaborate effectively within a team environment, contributing to team goals and supporting team members as needed Provide support to office of CMO and Clinical Success team Research clinical compliance best practices and any regulatory requirements as needed. Review member amendment requests and present findings to the CMO with recommendations for next steps. Other duties as assigned