Compliance Reviewer

Texas Health & Human Services Commission•Fort Worth, TX

6d•$57,614 - $93,138•Hybrid

About The Position

Under the supervision of the Quality Assurance Regional Programs (QARP) Manager, the QA Compliance Reviewer reviews and provides corrections and feedback for deficiencies and violations written across the state for regulated programs such as Nursing Facilities (NF) and Licensed Only Facilities (LOF). Licensed only facilities include: Assisted Living Facilities (ALF), Day Habilitation (DAHS) Services and/or Individual Support Services (ISS). This position conducts reviews and makes state and federal quality assurance recommendations based on the Center for Medicare and Medicaid Services (CMS) Principles of Documentation (PoD). The Compliance Reviewer provides consultation and guidance in the development and revision of NF/LOF statewide quality assurance related processes, training, and policies. The Compliance Reviewer provides professional regulatory feedback to surveyors, program managers, other state office level program staff, and may assist Quality Assurance and Program Integrity leadership in related decision-making. This position may communicate with CMS related to State Performance Standards (SPSS) or other compliance or enforcement concerns. The Compliance Reviewer communicates with internal staff to ensure consistency of quality assurance information and may be a witness at hearings. The QA Compliance Reviewer participates in work groups, committees, and meetings as the quality assurance representative and subject matter expert. Reviews certification, licensure, and all other long-term care onsite visit reports for compliance with state laws, regulations, and policies and procedures. Ensures reports follow established protocols and are accurately documented. This position also reviews and verifies information documents and data entry performed by others, as well as participates in review committees, prepares analysis of data for review and identification of staff training needs. Performs IJ/IT calls according to QA process document. This includes the invite, the call itself, data entry, the follow up email and all IJ/IT processes. The Compliance Reviewer also assists the Quality Assurance Regional Programs Manager with other tasks as assigned.

Requirements

Knowledge of state and federal laws and rules related to one or more of the above-named program areas.
Familiar with updated internal memoranda and program guidance.
Familiar with ASPEN, iQies and TULIP software programs with willingness and ability to learn new software programs.
Knowledge of state and federal laws and rules related to long-term care providers.
Knowledge of enforcement actions, survey and program activities related to the aforementioned program areas.
Knowledge of the State Performance Standards as mandated by CMS.
Knowledge of applicable agency program policy and monitoring systems.
Skilled in the use of computers and applicable software including Microsoft Word, Outlook, TEAMS, SharePoint, and Excel programs.
Skilled in problem solving and decision-making.
Ability to gather, organize and analyze facts; to compile and prepare reports; to develop and evaluate policies and procedures and initiate modifications or revisions as appropriate.
Ability to interpret policies, rules, and regulatory language.
Ability to communicate (verbally and written) with leadership, agency staff, stakeholders, and the public.
Ability to adjust work routine according to priorities.
Ability to establish and maintain professional and effective working relationships.
Ability to effectively interact with others in political/stressful situations.
Ability to work independently.
Ability to exercise professional judgment and reach sound decisions.
Ability to integrate complex concepts into difficult procedures, or complicated processes.
Ability to multi-task and track multiple activities with competing priorities.
Must possess SMQT qualification
2 years’ experience in Long Term Care Regulation related to Nursing Facilities required.

Nice To Haves

Registered Nurse (RN) Texas licensure preferred.
Additional experience in Licensed-Only facilities (ISS, DAHS, ALF) preferred
A Bachelor’s degree from an accredited college or university in a human service field is preferred but not required.
A combination of work experience and education may substitute (year for year) for a bachelor’s degree.
Experience interpreting or overseeing compliance with state and federal licensure regulations and standards preferred

Responsibilities

Develops and maintains quality assurance tracking systems for quality assurance reviews.
Monitors and tracks survey processes from exit through quality assurance and enforcement reviews.
Facilitates State Office level Immediate Jeopardy and Immediate Threat vetting calls to provide determinations and recommendations within the program of expertise.
Reviews and analyzes survey findings to determine if evidence supports a deficiency/violation and is written in accordance with the PoD and LTCR standards.
Provides guidance to regions and state office regulatory staff on compliance issues by interpreting policies, regulations, management directives, rules and state and federal guidance letters.
Provides clarification to regional staff to ensure strength of future deficiencies resulting in remedies being imposed.
Communicates with Center for Medicare and Medicaid Services (CMS) for directives and guidance related to specific compliance topics and State Performance Standards.
Reviews draft policies, trainings, and guidance to ensure they conform to federal and/or state requirements as applicable.
Consults with internal stakeholders to ensure that consistent quality assurance-related information is provided statewide.
Participates in workgroups, committees, and meetings as the subject matter expert and quality assurance representative.
Responds to management, media, and legislative inquiries as appropriate.
Compiles monthly reports of quality assurance activities noting patterns and trends.
May be required to develop and facilitate presentations related to data trends, quality assurance and consistency.
May be a witness at hearings.