Job Overview
Company:Maxim Healthcare Services
Job Title:Compliance Specialist - Registered Nurse / RN- West
Job Location:San Francisco, CA (map it!Map it!)
Job Type:Health Care
Job Education:4 Year Degree
Required Experience:Not Specified
Job Employment Type: Full-Time
Job Travel:Not Specified
Job Industry:Healthcare - Health Services
Job Posted Date:10/18/2014
Contact:Not Available
Phone:Not Available
E-Mail:Not Available
Fax:Fax: Not Available
Job Ref ID:HEA003L6

Maxim Healthcare Services has become one of the largest and fastest growing healthcare companies in North America by providing solutions that aim to improve health and quality of life. Established in 1988 to respond to the nursing shortage, Maxim Healthcare Services carries with it a rich tradition of striving to provide superior service. As a leader in the fields of medical staffing, home healthcare, and wellness services, Maxim is an evolving company that has assisted many of the nation’s hospitals, nursing homes, school systems, and other medical facilities with a full spectrum of healthcare needs. Our company has grown from a small team of eager recruiters to a corporation with satisfied clients in nearly every corner of the nation. The success behind the evolution of Maxim’s growth is our expectation for excellence in recruitment, retention, and customer care. Our clients can rest assured that the future brings with it new opportunities for continued success.
Maxim Healthcare Services is currently seeking qualified applicants for the role of a Compliance Specialist - Registered Nurse - RN. The primary responsibility of the Compliance Specialist is to review clinical medical records and claims for accuracy of services related to home health care.  The Compliance Specialist maintains a comprehensive understanding of ethical principles and independence in their work, professional conduct, duty, and responsibilities.  The Compliance Specialist is obligated to articulate principles, have a working knowledge of the rules and regulations as they pertain to all aspects of home healthcare, and observe/ensure the highest level of professional standards, quality care, and legal aspects. Essential Duties and Responsibilities:
  • Reviews clinical medical records and claims for accuracy of services related to clinical standards of practice and care, levels of care, quality indicators, medical necessity, length(s) of stay, billing, and denials
  • Makes proposals related to compliance and continuous quality improvement
  • Conducts exit conferences and provides timely written feedback
  • Works collaboratively with Regional Operations and Site Managers
  • Participates in provider educational programs
  • Serves as a resource, providing information generated from a sound basis
  • Ensures confidentiality of medical information related to HIPAA regulations
  • Displays dedication to corporate objectives
  • Performs audits as scheduled by the Compliance Leadership team
  • Completes work product in an accurate and timely fashion as required by the Compliance Leadership team
  • Ensures business travel is consistent with the business objectives of the Compliance Department, and submits all expense reimbursement requests within 30 days of site visit
  • Assists with clinical review for claims testing activities
  • Assists with clinical review for issues investigation and resolution
  • Performs other duties as assigned/necessary
Maxim Healthcare Services is one of the leading providers of medical staffing, home health and wellness services in the United States.  Founded in 1988, Maxim has rapidly expanded to include 12 divisions and over 400 branch offices in 44 states and the District of Columbia.  We have earned a position as an innovative leader in the healthcare industry through our emphasis on quality patient care, compliance initiatives and customer service.  Today, Maxim is one of the largest privately owned companies in our industry. Maxim has committed itself to achieving exemplary corporate citizenship, best practices of effective corporate governance, the highest levels of integrity and professionalism, integrity in the operation of federal healthcare programs, and a culture of openness, accountability and compliance throughout Maxim.
Minimum Requirements:
  • RN/BSN degree or other commensurate healthcare degree
  • Experience in Utilization Review, Risk Management, Quality Management, Documentation Specialization, Nurse Management, Compliance, Billing, Coding, or CFE, LNC, or CPUR certification
  • At least five years of clinical experience - Critical Care/Home Health Care preferred
  • Demonstrated knowledge of Clinical Compliance, Best Practices, Medical Record Review, Legal Aspects of Documentation, etc
  • Demonstrated knowledge of CPT, ICD-9 codes, DRGs, and APC coding
  • Understanding of payer rules and regulations, including Medicare and Medicaid
  • Ability to set priorities and meet timelines for performance expectations, while maintaining strong attention to detail
  • Ability to work independently with minimal supervision, and demonstrate initiative
  • Excellent interpersonal and communication skills
  • Must demonstrate sound judgment and decision-making
  • Must successfully articulate rationale and deliver difficult messages in a constructive manner; must be diplomatic in the face of adversity
  • Computer proficiency, including programs such as MS Office, Word, Excel, email, and internet research, required
  • Must be ethical and possess the ability to remain impartial and objective
  • Must exemplify strong, positive leadership skills
  • Must possess the ability to educate and train Compliance and Clinical standards to staff members
  • Must be able to travel 80-90% of the work time
  • Must demonstrate character that enhances corporate interests and integrity
  • Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills; proficiency in the English language may be required

Our company is committed to maintaining a challenging environment that promotes personal accountability, personal growth, and an active role in the driving vision of the company. We offer competitive pay, full benefits including medical, dental and vision coverage as well as 401(k), 529 college savings plan, basic life insurance with the option of supplemental, and 17 days paid time off in addition to holidays and two floating holidays.

To learn more about Maxim Healthcare Services, please visit our website and apply online at
EOE/AAE  Keywords: RN, Registered Nurse, Nurse, nursing, homecare, home care, healthcare, health care, home health, home healthcare, med surge, ER, Emergency Room, ICU, intensive care unit, NICU, hospice, RN case manager, RN clinical supervisor, , r.n., rn, acute care, homecare manager, home care manager, clinical director, clinical administrator, patient care manager, director of nursing, DON, DOCS, field case manager, field clinical supervisor, director of clinical services, RN manager, registered nurse manager, RN supervisor, registered nurse supervisor, nurse management, nurse manager, RN director, registered nurse director, visit nurse, admission nurse, skilled visit, case management, pediatric clinical supervisor, pediatric case manager, home care nurse, homecare nurse, home health nurse, staff nurse

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