Compliance Reviewer

TX-HHSC-DSHS-DFPS-posted 6 days ago

Full-time • Mid Level

Remote • Austin, TX

1,001-5,000 employees

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Under the supervision of the Quality Assurance Regional Programs (QARP) Manager, the QARP Compliance Reviewer (CR) reviews certification and licensure forms that resulted in a deficient practice for Licensed only Facilities to include Assisted Living Facilities (ALF), Day Activity and Health Services (DAHS), Individualized Skills and Socialization (ISS) and Prescribed Pediatric Extended Care Centers (PPECC). The QARP CR may be required to review, analyze and evaluate Provider Investigations reports to determine compliance with federal, state and program requirements. The QARP CR participates in review committees, prepares data for review, and assists in identifying regional trends and patterns. The QARP CR performs advanced technical and professional reviews of certification surveys, licensure inspections, and investigations conducted in long term care facilities to determine compliance with state/federal requirements and protocols, and Long-Term Care-Regulatory (LTCR) policies and procedures. The QARP CR logs, facilitates and participates in IJ/IT vetting calls. This position also transforms qualitative data into quantitative data and assists with in-depth analysis of qualitative and quantitative program-specific data. This position also interprets statistical evidence and develops work plans, reports, and documentary support for program development and assessment. This position may be required to cross train in other provider types, and performs other duties as assigned.

Performs advanced technical and professional reviews of survey forms to ensure appropriateness and completeness based on the Principles of Documentation (PoD), The Centers for Medicaid and Medicare Services (CMS) State Operations Manual (SOM), compliance with state/federal regulations, and Long-term Care-Regulatory policies and procedures. May complete and documents quality assurance reviews of PI reports and communicate those findings to appropriate program staff.
Provides ongoing education, both onsite and virtually, to surveyors/inspectors and regional management.
Assists in compiling of data to show trends resulting from the QA review.
Maintains professional and technical knowledge for LTCR programs.
Excellent communication skills including the ability to manage self remotely.
Maintains a regular and predictable work schedule.
Consults with regional surveyors/inspectors, program managers, and other regional staff to clarify any discrepancies and works with the regional staff to recommend appropriate corrections.
Performs related work as assigned.

Knowledge and experience in HHSC Long Term Care Regulatory Programs.
Knowledge of federal and state laws, rules, program, and policies applicable to Long Term Care Regulatory.
Skill in managing multiple and competing priorities.
Skill in critical thinking to identify problems, evaluate alternatives, and recommend effective solutions.
Skill in use of personal computer and various software programs to include Word, Excel, PowerPoint, Teams, and Outlook.
Ability to accurately research, interpret, and apply pertinent statutes, rules, policies and procedures.
Ability to communicate effectively both orally and in writing.
Ability to present to large groups.
Ability to build, establish and maintain effective working relationships with diverse individuals and groups.
Current employee of Long-Term Care Regulatory with 12 months minimum survey experience in Licensed Only Facilities (LOF), Assisted Living Facilities (ALF), Day Activity and Health Services (DAHS), Individualized Skills and Socialization (ISS) and Prescribed Pediatric Extended Care Centers (PPECC) with 18 months preferred. Additionally, Provider Investigations experience preferred.
Experience in interpreting state rules and regulations for LOF required and Provider Investigations programs preferred.
Graduation from a four-year accredited college or university.

Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.

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