Job Description
Join a dynamic team dedicated to ensuring compliance across delegated entities within a managed medical health plan. As a Regulatory & Compliance Oversight Nurse, you will play a key role in conducting audits, managing Corrective Action Plans (CAPs), and supporting regulatory adherence to state and federal guidelines.
Conduct monthly audits using automated audit tools and Excel-based templates
Review random samples of 5 case files per month for compliance
Score delegate performance based on regulatory measures
Manage CAPs for delegates failing consecutive audits
Track CAP status, monitor responses, and ensure resolution of issues
Present CAP updates via slide decks and participate in bi-weekly clinical team meetings
Collaborate with Preferred Provider Groups (PPGs) to review clinical records
Maintain accurate documentation and engage in follow-up communications
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
Associate’s or Bachelor’s Degree in Nursing
Active RN certification
Minimum 5 years of clinical experience
Prior experience in managed medical health plans and utilization management
Familiarity with delegation oversight and compliance audits
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.