Nursing QCM Auditor

Position: Nursing QCM Auditor

Job Type: Full-Time Non-Exempt

Shift Details: 8:00am-5:00pm; Monday – Friday

Work Location: Remote – Travel Required Based on Business Need

Candidates MUST reside in one of these states: AZ, DE, FL, LA, MI, NC, OH,OK,OR,PA, TN,TX,UT, GA, NM, NV, SC, VA

Starting Salary: $80,000 – $88,000/year

Specialties / Licenses or Certifications:

• Active RN License in Operational State, Preferably Compact RN License

Summary of Job: The Nursing Quality Control Measure (QCM) Auditor is responsible for conducting audits and supporting compliance activities to ensure adherence to internal policies, regulatory standards, and accreditation requirements. This role contributes to maintaining and elevating Recovery Innovation’s quality by reviewing clinical documentation, identifying areas of non-compliance, and assisting in the implementation of corrective actions. The QCM Auditor works collaboratively with internal teams and supports cross-functional efforts to promote continuous improvement and regulatory readiness across programs and services.

Essential Duties and Responsibilities:

Compliance Support & Audit Preparation:

• Conduct audits of documentation to ensure compliance with clinical standards, scope of practice, and regulatory requirements.
• Collaborate with the Risk Team to help identify clinical compliance issues and assist in implementing risk mitigation strategies.
• Support the Project Management Office (PMO) in coordinating documentation and logistics for external audits.
• Assist in drafting responses to Notice of Findings (NOFs) from regulatory bodies such as The Joint Commission (TJC), CMS, and state regulatory agencies.
• Contribute to the development and tracking of Corrective Action Plans (CAP) related to nursing operations in conjunction with quality and compliance regulations and organize updates in a centralized system.

Training & Documentation:

• Participate in the preparation and facilitation of in-service trainings related to CAP implementation and audit readiness.
• Maintain accurate records of QCM and nursing-related trainings and ensure documentation meets audit and internal standards.

Communication & Record Management:

• Assist with external compliance-related communications involving clinical care, ensuring alignment with approved templates and leadership guidance.
• Support the processing of clinical records requests, subpoenas, and ensure adherence to HIPAA and ROI (Release of Information) protocols.

Information Management & File Review:

• Update internal platforms (e.g., HIM SharePoint) with new guidance and maintain informational content such as the “News You Can Use” section.
• Conduct routine audits of nursing and clinical files to verify documentation accuracy, timeliness, and compliance with regulatory standards.

Facility Licensing, Accreditation, & Facility Oversight:

• Monitor staff licensure and certification status and support site leaders by flagging expirations and assisting with tracking onboarding compliance.
• Perform periodic audits of clinical charts, infection control protocols, and facility operations to ensure compliance with internal standards.
• Support site readiness for inspections and surveys by maintaining documentation and assisting with compliance audits, corrective action plans, and ongoing monitoring.
• Collaborate with leadership and departments (e.g., Clinical Operations, Facilities, HR) to ensure continuous accreditation compliance across all facilities.

Quality & Inspection Support:

• Obtain and maintain Compliance Site Lead certification to support QMS activities at the site level.
• Participate in site readiness reviews and assist the Quality team in follow-up audits, inspections, and corrective action tracking.

Additional Duties:

• Understands and adheres to Recovery Innovations compliance standards as they appear in the Code of Conduct and Conflict of Interest Policies.
• Keeps abreast of all federal and state regulations and laws and all Recovery Innovations policies as they presently exist and as they change or are modified.
• Performs other related duties assigned.

Your well-being and success are our priority at RI—explore our benefits and discover how we invest in YOU every step of the way! As an innovative leader in behavioral health care, we are committed to supporting our teams through a comprehensive benefits package. This includes competitive health, dental, and vision insurance, as well as access to mental health resources and wellness programs. We offer a strong retirement plan with company matching and generous paid time off to support work-life balance. In addition, we provide ongoing opportunities for professional development and training to help you advance in your career. We value the contributions of our team members and are dedicated to fostering a supportive, inclusive environment where you can thrive both personally and professionally.

Job Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Education:

• Licensed Registered Nurse in operational state required, compact license preferred.
• Bachelor’s degree in Healthcare Administration, Public Health, Behavioral Health, or related field; years of experience in lieu of advanced degree may be considered.
• Certified Health Care Compliance (CHC) in good standing preferred.

Experience:

• Minimum of 3 years as a Registered Nurse.
• Minimum of 2 years of clinical auditing experience.
• Minimum of 2 years of behavioral health program auditing and charting experience (required).
• Minimum of 2 years of experience creating and implementing policies and procedures.

Miscellaneous Requirement:

• Knowledge and understanding of:
• Medicaid requirements, payment methodologies, and compliance program requirements.
• Federal and state laws related to fraud, waste, and abuse (e.g., False Claims Act, Anti-Kickback Statute, exclusions, and conflicts of interest) (preferred).
• Proficiency in Microsoft Office Suite, especially in: Creating spreadsheets (e.g., Excel) Developing charts and visual graphics (e.g., PowerPoint)
• Strong interpersonal and communication skills (written and verbal).
• Excellent customer service skills.
• Ability to build effective relationships across multiple levels of the organization.
• Ability to interpret and apply compliance standards in practice.
• Demonstrated ability to communicate effectively both verbally and in writing.
• Ability to exercise considerable judgment and discretion.
• Travel required based on business need.
• Must be at least 18 years or older.
• Ability to maintain a high level of confidentiality (HIPAA guidelines and regulations) and professionalism.
• We are a Second-Chance Employer
• Must be able to pass a seven-year background check.
• Must be able to pass substance abuse testing and/or tuberculous testing (if applicable).
• Must be able to pass education verification check.
• Must be able to obtain designated fingerprinting clearance card in applicable states
• Must be able to pass three-year motor vehicle report and meet minimum eligibility requirements criteria of insurance carrier (if driving is required for this position).

Driving Requirements:

• If driving is required for this position, must meet all requirements outlined in Recovery Innovations driving policy.
• If not qualified to drive per driving policy, a Non-Driver Attestation form must be signed.

Physical Demands:

May include work close to the eyes and substantial motions of the wrist, hands, and/or fingers. Frequent sitting, standing, walking, handling, finger dexterity; eye-hand-foot coordination, use of corrected vision; color vision; use of auditory senses. May be required to lift up to twenty (20) pounds.

Work Environment

May work in an office environment or behavioral health facility. May have contact with individuals who are agitated and/or confused.

Recovery Innovations is committed to providing equal employment opportunities to all individuals. Our hiring practices are based on merit, qualifications, and abilities. We do not discriminate against any employee or applicant on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected by law. We strive to create a workplace where every employee feels valued and respected.

Recovery Innovations is a second chance employer and we evaluate all qualified applicants fairly, including those with criminal histories, in accordance with legal and funder requirements. If you need assistance and/or reasonable accommodation due to a disability during the application or the recruiting process, please send a request via the Accommodation request form.

Benefits/perks listed above may vary depending on the nature of your employment with Recovery Innovations.

The wage range for this role considers the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. At Recovery Innovations compensation decisions are dependent on the facts and circumstances of each case.