Registered Nurse Regulatory Specialist

Job Summary

Supporting regulatory compliance initiatives, the full-time remote Registered Nurse Regulatory Specialist will manage medical review requests, coordinate documentation for audits, and ensure adherence to healthcare regulations while collaborating with cross-functional teams.

Key responsibilities

• Support payer audits and medical record reviews, ensuring timely and accurate documentation submission
• Manage medical review requests and appeals with CMS contractors and regulatory agencies
• Participate in compliance monitoring initiatives and assist with risk identification activities

Required qualifications

• Current Registered Nurse (RN) license
• Minimum 3 years of clinical operational leadership or supervision experience within Home Health and/or Hospice
• Strong knowledge of CMS Home Health regulations and state/federal licensing standards
• Experience performing clinical chart reviews and documentation audits
• Ability to independently prioritize and manage work in a remote environment