Medical Program Compliance Nurse

TX-HHSC-DSHS-DFPS • Brenham, TX

13d • Onsite

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.

Come work in an environment where we truly value and respect those we serve and believe in the mission that all people can achieve a higher level of wellness and independence.

The state supported living centers serve people with intellectual and developmental disabilities who are medically fragile or who have behavioral problems. The centers provide campus-based direct services and supports at 13 centers located throughout the state. Learn About Our State Supported Living Centers

If you are looking for a place to work where you can establish a career that is filled with purpose, this is the job for you!

Free CEUs and updated resources through Lippincott access for all nurses.

The Medical Program Compliance Nurse (Nurse III) performs duties within the scope of practice attributed to the skills of a registered nurse and reports to the Medical Director or SSLC Director in the absence of a Medical Director. Coordinates and organizes medical services and activities related to medical program compliance. Oversees medical processes to ensure quality data is collected in order to create an accurate clinical picture of medical services provided to individuals served. Audits files, analyzes data, develops medical trend reports, and makes recommendations to address trends and deficiencies. Develops the medical department monitoring and audit tools, in conjunction with state-office discipline coordinator. Develops, reviews, and explains policies, procedures, protocols related to medical program and medical program compliance. Plans and oversees the medical department’s preparation, involvement and response to internal and external monitoring visits. Creates and reviews reports. Plans, develops, implements, and monitors medical services compliance programs and processes. Attends and provides information at assigned meetings. Provides treatment to HHS employees injured in course and scope of employment. Oversees, leads, monitors and/or supervises staff assigned to the medical department, as assigned. Works under limited supervision with considerable latitude for the use of initiative and independent judgement.

Requirements

• Considerable knowledge of nursing techniques, standards, and procedures; of health care laws and regulations; of medical diagnoses and procedures; of accepted medical treatment patterns; of community health and nursing care principles, practices, and procedures; of program regulations and procedures; and of utilization review and control measures.
• Knowledge of nursing care standards, the Settlement Agreement, and the Healthcare Guidelines or ability to quickly gain the knowledge.
• Knowledge of state and federal laws and Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) rules, regulations, policies, and procedures related to SSLCs or ability to quickly gain that knowledge.
• Knowledge of emergency procedures and emergency equipment, i.e., Cardiopulmonary Resuscitation (CPR), and ability to assess and care for residents and/or staff members in emergency situations.
• Skill in the use of computer/software and an electronic health record system.
• Skill in writing policy, procedures and guidelines.
• Excellent verbal and written communication skills and the ability to present ideas clearly and concisely in both written and oral communications.
• Skill in the care and treatment of patients.
• Ability to provide patient care; to prepare and maintain records; to organize, coordinate, and evaluate medical and nursing activities in the delivery of health services; to interpret policies and procedures; to interpret health care regulations; to recognize patterns of medical necessity treatment; and to provide technical assistance and consultation to others.
• Ability to identify trends, analyze data and maintain spreadsheets and databases.
• Ability to interpret regulations and communicate them effectively both orally and in writing.
• Ability to appropriately interact with individuals with intellectual/developmental disabilities, with their family members, and with staff members.
• Ability to work independently and productively with all levels of staff.
• Ability to train/in-service all levels of staff.
• Ability to make recommendations to SSLC leadership including on-call administrators.
• Must maintain current CPR certification. Must have strength and flexibility to safely perform CPR.
• Licensed to practice as a registered nurse in the State of Texas (or a state that recognizes reciprocity through the Nurse Licensure Compact).
• At least one (1) year experience as a practicing registered nurse is required.

Nice To Haves

• At least two (2) years of experience as a practicing registered nurse in a health agency, hospital, or health-care facility is preferred.
• Quality Assurance monitoring experience is preferred.
• Bachelor's Degree is preferred.
• Previous experience working with Individuals with Intellectual or Developmental Disabilities (IDD) is preferred.

Responsibilities

• Attends work on a regular basis and may be required to work a specific shift schedule or, at times, even a rotating schedule, extended shift and/or overtime in accordance with agency leave policy and performs other duties as assigned.
• May serve in an on-call status on a rotating schedule as required to meet operational needs of the facility.
• Coordinates with the Medical Director, State Office Coordinator, and QA department and organizes medical services activities related to medical program compliance. Oversees processes to ensure data is obtained in order to provide an accurate clinical picture of medical services provided to individuals served. Completes and/or oversees the completion of required reports and documentation.
• Develops the medical department monitoring processes and audit tools such as those used for document reviews/audits of items including but not limited to annual and quarterly assessments, general documentation, preventative care completion and any others deemed necessary for departmental improvement. Updates and revises monitoring tools and processes as necessary to ensure they remain in alignment with current policies, procedures and guidelines. Disseminates tools to designated subject matter experts monitoring findings and tracks through completion.
• Monitors, reviews and audits medical records, medical assessments, and medical interventions for compliance with policies, procedures, protocols and guidelines to promote best practices for quality of care. Collaborates with the QA Department and State Office Discipline Lead to oversee the completion of the Internal/External Medical Provider Audit Process to ensure interrater reliability by bringing multiple sources together to review for consistency and agreement on audit scoring.
• Collects and enters the information generated from tools into local or statewide tracking systems as appropriate, so that the data can be tracked and analyzed. Analyzes data to develop medical trend reports for review and approval by the Medical Director to be presented at the Quality Assurance/Quality Improvement (QAQI) meeting. Ensures analysis of auditing and recommendations are shared with applicable medical department administration members and medical providers. Summarizes findings and provides recommendations for actions to be taken to address trends and deficiencies. Routinely collaborates with medical administration team to develop corrective actions and measure progress towards improved compliance.
• Develops, reviews, and explains policies, procedures, protocols related to medical program and medical program compliance in conjunction with the Medical Director and/or State office discipline coordinator. Makes recommendations for, and assists with, changes to medical policies, procedures and protocols to enhance the quality of services and compliance with requirements. Makes recommendations to the Medical Director/Lead PCP on how to improve processes to ensure quality services for individuals.
• Plans and oversees the medical department’s preparation and response to regulatory survey, Department of Justice (DOJ) Settlement Agreement and other internal and external monitoring visits. Pulls documents and reviews documents pulled by others for sufficiency and correctness before submission to monitors and auditors. Provides quality assurance checks for the medical department to ensure all documents are of good quality and provide a comprehensive and responsive package of information. Participates in the review process as assigned such as participating in medical department observations and providing feedback to medical providers on identified concerns. Performs interrater reliability tasks, so as to demonstrate the SSLCs ability to provide self-monitoring. Reviews written reports provided by auditors and monitors and provides comments and recommended edits. As assigned, develops, implements, and tracks medical quality improvement plan(s) to improve quality of care and address issues noted in monitoring reports.
• Gathers and performs data analysis on medication variances determined to be medical prescribing variances and participates in medical variance meetings to discuss departmental trends and findings.
• Attends and provides information at assigned meetings such as Root Cause Analysis (RCA), medication variance meetings, infection control meetings, QAQI, departmental medical meetings, and state-wide medical compliance nurse meetings. Participates in other monthly meetings and committees as assigned to discuss medical department data and determine corrective action when needed.
• Provides consultation, training, and technical assistance to the subject matter experts such as the Medical Director and medical providers, and other specialty nurses to effectively use the monitoring and auditing tools. Collaborates with the Medical Director and State Office Discipline Lead to develop educational materials and provide education to the medical providers on such topics as Quality Improvement Plans (QIPs), Corrective Actions Plans (CAPs), areas of deficiency within the medical department and what is needed to address deficiencies. Collaborates with the Medical Director on new employee orientation and ongoing training and development. Provides direct, real time feedback and coaching to medical providers when performing documentation audits, such as reviewing annual and quarterly assessments and daily progress notes, to improve their skills and the quality of services. Conducts outreach activities to other departments within the SSLC or to external entities, providing information sessions as assigned such as during a recruitment event or skills development events.
• Assists the Medical Director by providing leadership and oversight within the medical department such as overseeing the work of, coaching and monitoring services provided by Licensed Vocational Nurses (LVNs) assigned to the medical department. As determined by the needs to the particular SSLC medical department, directly supervises assigned department staff such as LVN IIs and IIIs. Assists in developing guidelines for the medical program compliance nurse position as assigned. Cross trains at least one designee to perform medical program compliance duties. Provides direct care nursing services as needed. Provides treatment to HHS employees injured in course and scope of employment.
• Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1-10 employees