Manager Regulatory Affair at Capgemini Engineering coordinating activities for the US market. Preparing submissions to the FDA and collaborating with internal teams for regulatory compliance.
About the role
- Clinical Compliance Manager leading clinical compliance and risk mitigation efforts for Texas Health Action. Overseeing documentation audits and compliance with healthcare regulations and standards.
Responsibilities
- Lead clinical documentation, coding, and medical necessity audits (E/M, telehealth, specialty services, risk adjustment) and deliver actionable findings, provider education, and trend analysis
- Provide compliance oversight of provider competency, onboarding, credentialing, and privileging processes in alignment with regulatory and accreditation requirements
- Support clinical governance through participation in peer review, performance reviews, quality councils, and multidisciplinary committees
- Oversee infection prevention and clinical safety compliance, including immunization protocols, exposure control, incident reporting, and environmental rounds
- Identify clinical safety risks, conduct incident reviews and root-cause analyses, and track remediation to completion
- Drive regulatory readiness for accreditation surveys, payer audits, and inspections through gap analysis and compliance assessments
- Provide governance and oversight for peer review and utilization review programs to ensure appropriateness of care and adherence to payer and evidence-based standards
- Lead development, review, and implementation of clinical policies, procedures, and practice guidelines aligned with evidence-based standards
- Develop and deliver system-wide education on clinical compliance, documentation accuracy, emerging regulations, and quality standards
- Monitor, analyze, and report clinical compliance metrics, audit results, and risk trends to clinical and executive leadership
- Partner closely with Continuous Quality Improvement (CQI), Risk, and Corporate Compliance teams to translate regulatory findings into sustainable quality improvement initiatives
Requirements
- Bachelor’s degree in nursing, health information management, healthcare administration, or a related field required; clinical licensure (RN, PA, NP, LVN, RT, etc.) is strongly preferred.
- Certification preferred: CIC, CPHQ, CCS, RHIA/RHIT, CHC, or other clinical/quality/compliance credentials.
- 3–5 years of experience in clinical compliance, quality management, HIM/coding, infection control, or clinical operations.
- Strong working knowledge of clinical documentation standards, coding regulations, accreditation requirements, and payer medical necessity guidelines.
- Experience with EHR systems, audit tools, incident reporting systems, and clinical quality analytics.
- Prior experience working with LGBTQIA+ and/or other marginalized communities strongly preferred.
- Must have basic PC skills that include a combination of working in a Windows Operating System and Microsoft Outlook, Word, and Excel.
- Understands the importance of maintaining confidentiality; able to maintain confidentiality under HIPAA standards.
- Must have the ability to exercise a high degree of diplomacy and tact; excellent customer services and interpersonal communication skills; Cultural sensitivity and demonstrated ability to work with diverse people groups.
- Well-developed verbal and written communication skills in English; Additional language abilities desirable.
- Ability to work well under pressure with minimal supervision.
- Ability to effectively interact with persons of widely diverse roles, backgrounds, cultures, and socio-economic classes, those in crises or resistant or negative toward organizations.
- Ability to apply time management practices to prioritize, schedule and complete work effectively to comply with mandated policies and deadlines.
- Ability to work on multiple tasks or parts of tasks simultaneously to ensure timely completion of work activities.
- Must be able to work productively with other departments and employees.
- Ability to work with professionals from various partners and organizations.
- Usually works forty (40) hours per week, some weekends may be required.
- Ability to successfully manage conflict, negotiating “win-win” solutions.
- Must be able to multi-task, prioritize with strong time management skills.
- Exceptional follow-through on tasks and assignments
- Must possess leadership qualities and be able to supervise and secure the cooperation of staff
Benefits
- Health Care Plan (Medical, Dental & Vision)
- Retirement Plan (403b)
- Life Insurance (Basic, Voluntary & AD&D)
- Paid Time Off (Vacation, Sick & Holidays)
- Short-Term & Long-Term Disability
- Training & Development
- Parental Leave
- Longevity Pay
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