Enforcement Compliance Reviewer

TX-HHSC-DSHS-DFPS•Austin, TX

2d•Hybrid

About The Position

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. 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. Explore more details on the Benefits of Working at HHS webpage. Has broad knowledge of Day Activity Health Services (DAHS); Home and Community Support Services Agencies (HCSSA); Individualized Skills and Socialization (ISS); Prescribed Pediatric Extended Care Centers (PPECC); and/or Home and Community-based Services (HCS) and Texas Home Living (TxHmL) programs. Has broad knowledge of Medicare, Medicaid, and/or State Licensing regulations relating to DAHS, HCSSA, ISS, and PPECC programs; and/or certification rules relating to HCS and TxHmL programs. Has general understanding of disease processes and treatments for pediatrics, adults, and geriatrics. Has broad knowledge of intellectual and developmental disabilities. Applies analytical and critical thinking skills using the Issue, Rule, Application and Conclusion (IRAC) method in the review of state licensing violations for DAHS, HCSSA, ISS, and PPECC to ensure accuracy pursuant to state licensing standards. Applies analytical and critical thinking skills using the Issue, Rule, Application and Conclusion (IRAC) method in the review of state certification principle violations for HCS and TxHmL to ensure accuracy pursuant to state certification standards. Performs Informal Dispute Resolution (IDR) reviews of state licensing violations and prepares detailed narrative of decisions and rationales. Performs review of Opportunity to Show Compliance (OSC) packets to determine if enforcement action is supportable and warranted. Provides consultation, interpretation and or clarification of rules and standards relating to DAHS, HCSSA, ISS, and PPECC. Provides consultation, interpretation and or clarification of rules and principles relating to HCS and TxHmL. Participates in work groups and meetings related to DAHS, HCSSA, ISS, PPECC, HCS, and TxHmL. Performs quality management of assignments including proofing, follow-up, tracking and monitoring, and data entry in applicable program databases including but not limited to TULIP, SharePoint, Access. Attends enforcement case pre-hearing conferences and hearings related to enforcement actions of DAHS, HCSSA, ISS, PPECC, HCS, and TxHmL. Must be able to communicate on a complex and professional level with others, internally and externally. Must attend and complete all required training related to the DAHS, HCSSA, ISS, PPECC, HCS, and TxHmL programs.

Requirements

Knowledge of the administration and provision care under Day Activity Health Services (DAHS); Home and Community Support Services Agencies (HCSSA); Individualized Skills and Socialization (ISS); Prescribed Pediatric Extended Care Centers (PPECC); and/or Home and Community-based Services (HCS) and Texas Home Living (TxHmL) programs or other long-term care programs.
Knowledge of Medicare, Medicaid, and/or state licensing rules relating to DAHS, HCSSA, ISS, and PPECC, or other long-term care programs; and/or certification rules relating to HCS and TxHmL programs.
Knowledge of regulatory activities including inspections/surveys, investigations, and/or enforcement.
Ability to gather, organize, analyze facts; compile and prepare reports; effectively enter and track data, develop and evaluate policies and procedures and initiate modifications as needed.
Ability to perform work independently and operate effectively within established guidelines and timeframes.
Ability to establish and maintain effective working relationships with managers, team members, internal and external stakeholders.
Ability to communicate effectively both orally and in writing.
Skill in operating computers and in using computer software.
Experience in long-term care regulatory services.
Experience in DAHS, HCSSA, ISS, PPECC, HCS or TxHmL programs.
Experience in surveys, investigations, or enforcement of long-term care regulatory services.
Experience in long term care facilities.
Graduation from an accredited college or university with a degree in a related field of health care, social services, or legal services.
Experience in regulatory services may be substituted for education on year-to-year basis.

Responsibilities

Performs review and analysis of Day Activity Health Services (DAHS), Home and Community Support Services Agencies (HCSSA), Individualized Skills and Socialization (ISS), and Prescribed Pediatric Extended Care Centers (PPECC) state licensing violations. Performs review and analysis of Home and Community-based Services (HCS) and Texas Home Living (TxHmL) state certification principle violations. Implements the Issue, Rule, Application and Conclusion (IRAC) method to determine whether the documented evidence and packets supports a determination of noncompliance and whether violations warrant enforcement action.
Performs quality management of assignments, maintains systems for follow-up and tracking of assignments, and performs data entry in applicable program databases including but not limited to TULIP, SharePoint, Access.
Conducts Informal Dispute Resolution (IDR) reviews of State Licensing violations. Communicates with IDR requestors for clarifications and additional information as needed. Prepares detailed narrative of rationale and decision. Utilizes all resources, peers, and literature for clarification.
Reviews Opportunity to Show Compliance (OSC) packets to determine if the recommended action is warranted and supportable. Prepares detailed narrative of rationale and decision. Utilizes all resources, peers, and literature for clarification.
Communicates with regional and state office staff to provide consultation, interpretation, guidance, and clarification of DAHS, HCSSA, ISS, PPECC, HCS, and TxHmL standards, principles, and rules; and participates in work groups representing DAHS, HCSSA, ISS, PPECC, HCS, and TxHmL enforcement, as needed.
Attends and completes all required trainings applicable to the DAHS, HCSSA, ISS, PPECC, HCS, and TxHmL programs. Attends work on a regular and predictable schedule and performs other duties as assigned.
Attends enforcement case pre-hearing conferences and hearings related to enforcement actions of DAHS, HCSSA, ISS, PPECC, HCS, and TxHmL.