PS Clinical Compliance Officer

Edtech.com's Summary

University of Utah is hiring a PS Clinical Compliance Officer. The role involves conducting medical necessity audits, coordinating regulatory and payment integrity audits, developing compliance policies, providing training, and mentoring team members to ensure adherence to University, State, and Federal guidelines.

Highlights

Conduct medical necessity reviews using standard tools like InterQual or Milliman.

Coordinate and respond to internal and governmental audits related to regulatory and payment integrity.

Develop, monitor, and update compliance policies, procedures, training, and education programs.

Provide expert consultation in compliance issue resolution and assist departments in compliance monitoring.

Manage audit requests based on risk, timelines, and personnel resources.

Required clinical licensure as a Physician's Assistant or Registered Nurse with patient care or medical review experience.

Proficiency with word processing, spreadsheets, and related computer applications.

Coding certification (CPC, ACS, CCS-P/H, RHIA, or RHIT) may be required; knowledge of ICD-10, CPT, HCPCS, and DRG coding preferred.

Salary range: $78,000 - $100,000 per year.

Department: Compliance Services; VP Area: U of U Health - Academics; Full-time, hybrid work schedule.

PS Clinical Compliance Officer Full Description

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Please see Special Instructions for more details.

Writing and Competency test will be requested.

Announcement

Details

Open Date	12/23/2025
Requisition Number	PRN43910B
Job Title	PS Clinical Compliance Officer
Working Title	Regulatory Compliance Administrator Hybrid/Remote
Career Progression Track	G
Track Level
FLSA Code	Professional
Patient Sensitive Job Code?	No
Standard Hours per Week	40
Full Time or Part Time?	Full Time
Shift	Day
Work Schedule Summary	Hybrid Schedule
VP Area	U of U Health - Academics
Department	01663 - COMPLIANCE SERVICES
Location	Campus
City	Salt Lake City, UT
Type of Recruitment	External Posting
Pay Rate Range	$78,000-$100,000
Close Date	03/22/2026
Priority Review Date (Note - Posting may close at any time)
Job Summary	The Regulatory Compliance Administrator collaborates with providers, managers, and staff to assist departments, clinics, and/or service lines in implementing, coordinating, and monitoring compliance practices. This incumbent is responsible for conducting medical necessity audits by reviewing clinical practice standards and documentation. The incumbent will conduct and respond to audits and projects related to regulatory and payment integrity to ensure accurate and timely responses to governmental contractors. In addition to the clinical expertise needed for the medical necessity reviews, the incumbent will perform scheduled and unscheduled regulatory and payment integrity audits, develop and standardize policies and procedures, training and education, compliance investigations, and reporting to ensure compliance with University, State, and Federal guidelines. The incumbent must be highly skilled in time management and possess strong communication skills. The incumbent will work with their team to evaluate and review individual skills and knowledge level and assign tasks accordingly. Must be able to provide mentoring to supporting roles within the team. This position is not responsible for providing patient care. This position has the possibility of remote work.
Responsibilities	Essential Functions: Maintains current knowledge regarding federal and state guidance, organizational needs, and regulations. This position prioritizes governmental and internal audit requests and needs based on risk, timelines, and available skilled personnel. Reviews documentation for medical necessity and utilizes industry standard tools such as InterQual or Milliman. Teams with providers and staff to assist departments in implementing compliance practices and monitors and coordinates those activities with the departments. Assists the University in preparing and completing regulatory audits by developing, monitoring, and updating quality controls and recommending actions to maintain compliance. Oversees, coordinates, and conducts audits/investigations to ensure compliance with University, State, and Federal guidelines. Analyzes and documents compliance processes. Recommends enhancements to policies and procedures for compliance review. Designs and implements training and education programs to enhance compliance awareness. Serves as an expert resource in compliance issue resolution. This job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job Work Environment and Level of Frequency typically required Nearly Continuously: Office environment. Physical Requirements and Level of Frequency that may be required Nearly Continuously: Sitting, hearing, listening, talking. Often: Repetitive hand motion (such as typing), walking. Seldom: Bending, reaching overhead.
Minimum Qualifications	Current licensure to practice as a Physician’s Assistant in the State of Utah and minimum three years of experience in a patient care capacity OR current licensure to practice as a Registered Nurse (BSN or APRN) in the State of Utah and minimum five years of experience working in a patient care capacity or equivalency (one year of education can be substituted for two years of related work experience). Patient care experience may be substituted with equivalent years of experience in medical necessity review. Must be proficient with word processing, spreadsheet and related computer applications and have exemplary human relations and effective communication skills. Requires a sound knowledge of clinical practice and exceptional critical thinking and leadership abilities. Department may require coding certification (CPC, ACS, CCS-P/H, RHIA, or RHIT). Preferences Knowledge of utilization review and quality assurance procedures as well as experience with InterQual or Milliman and Robertson and Case Management procedures of medical necessity auditing. This position is patient-sensitive and must fulfill all associated requirements. We protect our patients, coworkers, and community by requiring all patient-sensitive employees to be immunized according to CDC standards and hospital policy. Limited exemptions may be made for documented medical contraindications or religious beliefs that object to vaccinations.
Preferences	Knowledge of utilization review and quality assurance procedures, as well as experience with InterQual or Milliman and Case Management procedures of medical necessity auditing. Bachelor’s Degree in Health Care Administration, Business Administration, or a related field, or the equivalent. Knowledge of medical auditing, Federal healthcare program policies and requirements (including Medicare Parts A and B), and ICD-10, CPT, HCPCS, DRG coding. Coding certification (CPC, CPC-H, ACS, CCS-P/H, RHIA). If not current, must be willing to obtain within the first six months of employment. Certified in Healthcare Compliance (CHC) from the Health Care Compliance Association (HCCA). If not current, must be willing to obtain within the first six months of employment.
Type	Benefited Staff
Special Instructions Summary	Writing and Competency test will be requested.
Additional Information	The University is a participating employer with Utah Retirement Systems (“URS”). Eligible new hires with prior URS service, may elect to enroll in URS if they make the election before they become eligible for retirement (usually the first day of work). Contact Human Resources at (801) 581-7447 for information. Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS’ post-retirement rules and restrictions. Please contact Utah Retirement Systems at (801) 366-7770 or (800) 695-4877 or University Human Resource Management at (801) 581-7447 if you have questions regarding the post-retirement rules. This position may require the successful completion of a criminal background check and/or drug screen. The University of Utah values candidates who have experience working in settings with students and patients from all backgrounds and possess a strong commitment to improving access to higher education and quality healthcare for historically underrepresented students and patients. All qualified individuals are strongly encouraged to apply. Veterans’ preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. The University of Utah is an Affirmative Action/Equal Opportunity employer and does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran’s status. The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both. To request a reasonable accommodation for a disability or if you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity and Affirmative Action (OEO/AA). More information, including the Director/Title IX Coordinator’s office address, electronic mail address, and telephone number can be located at: https://www.utah.edu/nondiscrimination/ Online reports may be submitted at oeo.utah.edu https://safety.utah.edu/safetyreport This report includes statistics about criminal offenses, hate crimes, arrests and referrals for disciplinary action, and Violence Against Women Act offenses. They also provide information about safety and security-related services offered by the University of Utah. A paper copy can be obtained by request at the Department of Public Safety located at 1658 East 500 South.

Posting Specific Questions

Required fields are indicated with an asterisk (*).

* How many years of related work experience do you have?
- None
- Less than 3 years
- 3 years or more, but less than 5 years
- 5 years or more, but less than 7 years
- 7 years or more, but less than 9 years
- 9 years or more
* Do you have a current clinical license or patient care experience equivalency? (See qualifications for more details.)
- Yes
- No
* Indicate your level of knowledge of medical auditing, Federal healthcare program policies including Medicare Parts A and B, and ICD-9, CPT, HCPCS, DRG coding:
- None
- Minimal
- Moderate
- Extensive

Applicant Documents

Required Documents

Resume
List of References

Optional Documents

University Human Resource Management
250 East 200 South, Suite 125 Salt Lake City, UT 84111
Contact us: (801) 581-2169 By Email: employment@utah.edu

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Original Job Description