Registered Nurse Compliance Partner

About the Opportunity

Ensign Services, Inc.’s (ESI) Compliance Department is seeking a Registered Nurse - Compliance Partner. Must be a Registered Nurse with at least five years’ nursing experience in the skilled nursing environment. Primary responsibilities will involve performing clinical compliance audits, conducting internal investigations under direction of associate and chief compliance officer, reviewing and analyzing medical records and/or claims to detect possible compliance or quality issues.

About the Company

ESI currently serves over 200 health care operations in the Western United States, and is expanding. These operations are supported by ESI’s “Service Center,” a world-class service team that provides clinical, legal, human resources, accounting, compliance, information technology, construction and other resources necessary to allow on-site leaders to focus squarely on day-to-day business.

Our compliance philosophy is to work as closely with field facilities, agencies and resources as possible to develop solid relationships that allow us to enhance and foster compliance throughout the organization. We not only provide training, oversight and auditing functions, but we also serve as partners to our providers to assist them in building successful businesses in an ethical and compliant manner.

Duties

• Creates and presents regular training on Medicare claim management, clinical compliance and general healthcare compliance topics
• Performs clinical systems compliance audits
• Performs Medicare claim review portion of internal compliance audits
• Analyzes claims data and medical records to detect possible compliance or quality issues and works to assist operations to develop a corrective action plan to resolve the same
• Conducts internal investigations involving general compliance and clinical issues under the direction of a lead compliance partner or the chief compliance officer
• Provides advice and instruction on claim denial management and appeals
• Travel required 70% of the time within Texas and surrounding areas

Experience/Qualifications

• Registered Nurse
• A minimum of five years’ experience in a skilled nursing facility
• Infection Preventionist
• Understanding of the legal and regulatory framework governing the skilled nursing industry
• Ability to work with all levels of management on potentially complex compliance/regulatory issues
• Excellent communication skills.

Desired Skills

• Superior interpersonal communication skills
• Strong writing skills required to write and edit policies and procedures, compliance reports, and other communications
• Works well independently in a home office environment on long term projects and as a member of an interdisciplinary team
• An engaging and informative teacher for regular training of facility personnel regarding Medicare requirements
• Possesses and conveys high degree of credibility and integrity
• A desire to constantly improve Medicare management systems and organizational compliance
• Understands and accepts the unpredictable nature and needs of the compliance function in a large organization
• Exhibits analytical skills and an understanding of operational processes

Additional Information

• Salary: Commensurate with experience
• Number of Positions Available: 1
• Position Type: Full Time, Employee
• Benefits: Medical, dental, vision, life & AD&D Insurance Plans, 401(k) with matching contribution, vacation, sick and holiday pay
• Schedule: Typically business hours but may vary depending on workload and travel needs - 40 hrs/week
• Location: Based out of home office and regularly travels to assigned facilities; must reside near a major airport in one of the following area:
• San Antonio, Texas

Ensign Services, Inc. is an Equal Opportunity Employer.