Medicare Compliance Population Health RN

Medicare Compliance Population Health RN

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About Crossover Health
Crossover Health is creating the future of health as it should be. A national, team‑based medical group with a focus on wellbeing and prevention that extends beyond traditional sick care, the company delivers an entirely new model of healthcare—Primary Health—built on the foundation of trusted relationships, an interdisciplinary care team approach, and outcomes‑based payment. Crossover’s Primary Health model integrates primary care, physical medicine, mental health, health coaching, care navigation and more, and delivers care in surround‑sound—in‑person, virtually and via asynchronous messaging.

Together we are building a community of members that embraces healthcare as a proactive part of their lifestyle.

Job Summary
The Medicare Compliance Population Health RN supports the development and ongoing effectiveness of Crossover Health’s Medicare Advantage Compliance Program by ensuring compliance with Medicare Part C requirements, CMS regulations, and CMS standards. This role oversees regulatory updates, policy development, workflow improvement, and quality initiatives; conducts compliance training and education; performs internal audits and supports external reviews; identifies and mitigates compliance risks;

and serves as a liaison with Medicare Advantage Organizations. The RN acts as a clinical and population health resource for onsite and national teams, supports outreach initiatives, contributes to reporting and QBRs, and partners with leadership to ensure compliant, efficient, and high‑quality population health operations.

• Support the development and monitor effectiveness of Crossover Health’s Medicare Advantage Program.
• Manage compliance with Medicare Part C requirements, including risk adjustment and encounter data reporting.
• Monitor and implement applicable CMS updates and regulations affecting Crossover Health’s operations.
• Participate in quality improvement programs to ensure the practice is performing efficiently and in accordance with Crossover’s policies.
• Assist with ongoing development and maintenance of compliance policies; support protocols for documentation, coding, billing and patient communication that meet CMS standards.
• Assist with workflow design, process improvement, quality measurement, and issue resolution.
• Conduct regular compliance training for physicians, clinical staff, administrative personnel and governing board.
• Educate staff on fraud, waste, and abuse (FWA) prevention and reporting.
• Lead the training of new team members in CMS, outreach workflows, goals and expectations.
• Provide strategic advice and recommendations to the leadership team in the development, implementation, and evaluation of new or modified CMS policies, practices, and procedures.
• Perform internal audits of clinical documentation, coding and billing practices; coordinate with and support external auditors during compliance reviews.
• Audit outreach to ensure it meets Crossover standards.
• Identify compliance risks related to Medicare Advantage participation and implement mitigation strategies; investigate potential violations and support corrective action plans.
• Serve as liaison between Crossover Health and the Medicare Advantage Organization regarding compliance matters and contract compliance.
• Report compliance activities and findings to executive leadership.
• Maintain and update CMS resources.
• Lead onsite CMS efforts and advocate for both the client and the onsite and national teams.
• Demonstrate proficiency in the use of healthcare analytic tools, systems and analysis.
• Provide clinical support and serve as lead nurse resource for onsite team.
• Contribute to Q  presentations and discussions.
• Partner with onsite and national leadership and members of the Population Health team to ensure that care teams can perform CMS outreach and access resources.
• Support population health programs and clinic outreach initiatives.

• Graduate from an accredited school of nursing.
• Certification in Healthcare Compliance (CHC) or equivalent strongly…