Registered Nurse Compliance Manager

Job Summary The Registered Nurse (RN) – Compliance Manager is responsible for supporting organizational compliance with federal, state, and regulatory requirements related to clinical operations. This role conducts audits, monitors clinical documentation, supports quality improvement initiatives, and ensures adherence to applicable healthcare standards, including Medi-Cal, CMS, and state‑specific regulations. The RN – Compliance Manager partners closely with clinical leadership, ECM/Community Support teams, and operations to identify risk, implement corrective actions, and promote high‑quality, compliant patient care.

Duties/Responsibilities Conduct routine and focused clinical audits of medical records, care plans, and documentation to ensure compliance with regulatory and internal standards. Monitor adherence to Medi-Cal, CMS, and state‑specific program requirements (e.g., ECM, Community Support services). Identify compliance risks, trends, and gaps; escrow findings as appropriate.

Prepare detailed audit reports and present findings to leadership. Support Quality Assurance and Performance Improvement (QAPI) initiatives. Track and trend audit results, develop dashboards, and recommend corrective action plans.

Partner with leadership to implement and monitor performance improvement initiatives. Participate in internal and external audits, including readiness reviews. Ensure policies align with current regulatory requirements and best practices.

Partner with Clinical Directors, Care Managers, and leadership to address compliance concerns. Participate in interdisciplinary meetings to support quality and compliance initiatives. Serve as a resource for clinical compliance questions and guidance.

Maintain accurate records of audits, findings, and corrective actions. Support reporting requirements for internal leadership and regulatory agencies. Ensure timely follow‑up and resolution of identified issues.

Perform other duties as assigned. Education And Experience Active and unrestricted Registered Nurse (RN) license in Arizona and/or California. Minimum of 3–5 years of registered nursing experience.

At least 1–2 years of experience in compliance, quality assurance, or utilization review. Knowledge of Medi‑Cal, CMS, and/or managed care program requirements. Strong understanding of clinical documentation standards and regulatory compliance.

Required Skills/Abilities Strong analytical and critical thinking skills. Excellent written and verbal communication skills. Ability to interpret and apply complex regulations.

High attention to detail and organizational skills. Ability to manage multiple priorities and meet deadlines in a fast‑paced environment. Proficiency in EMR systems and Microsoft Office (Excel, Word, PowerPoint).

Physical Requirements Prolonged periods sitting at a desk and working on a computer. Must be able to lift up to 10 pounds at times. Pay range: $95,000 USD - $125,000 USD Benefits Medical, Dental, & Vision Benefits: We have various insurance options for you and your family.

Short & Long‑Term Disability Benefits: Protection when you need it most. Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones. Flexible Spending Accounts: Manage your finances with flexibility.

Employee Assistance Program (EAP): Support when life throws challenges your way. 401(K): Building your financial future with us. Effective after 1 year of employment. Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.

Paid Holidays: Quality time to enjoy celebrations. Employee Referral Program: Share the opportunities and reap the rewards. Company Discount Program: Enjoy savings on everyday expenses and memberships.

Equal Employment Opportunity Optima Medical Management Group and its divisions are an Equal Opportunity Employer. Optima MMG is committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status or any other characteristic protected by federal, state or local laws. Optima MMG is committed to providing reasonable accommodation for individuals with disabilities.

Pre-Employment Optima Medical Management Group is a drug‑free workplace. Employment is contingent upon a successful pre‑employment drug screening and background check. #J-18808-Ljbffr