OPERATIONS REVIEW SPECIALIST - 64007498

State of Florida • Tallahassee, FL

11d • Onsite

About The Position

Analyzes and processes medical/allied health complaints consisting of Code 15 Reports (Hospital, Nursing Home & Assisted Living Facility), civil malpractice settlements, civil complaints, hospital disciplinary reports, internet prescribing/unlicensed storefront pharmacies and consumer complaints against Florida health care licensees to determine conformity with existing quality assurance principles and standards. The hospital, nursing home & assisted living facility complaints are complex. Data is analyzed and employee develops solutions or alternative methods of proceeding or resolving issues. Consults with federal, state, and local organizations on matters related to the above reports/complaints. Interprets and applies statutes, policies, and regulations in analyzing complex data regarding patient care and malpractice issues involving health care practitioners. Reviews documents and/or contacts appropriate parties to ensure compliance with applicable statutory and regulatory requirements. Conducts investigations when appropriate; issues subpoenas, citations, cease and desist agreements and notices of non-compliance; contacts and interviews witnesses and experts as necessary when conducting investigations; prepares investigative reports and prepares file for legal review; testifies at hearings as necessary. Provides technical assistance, consultative services and direction for development, implementation and evaluation of data and reports. Researches, prepares, and disseminates reports of a topical or statistical nature as required by management or agency officials. Consults with, assists, and acts as liaison between and among the professional boards, complainants, licensees, consultants, other governmental agencies, and the various sections of the agency; assists in the development of consumer education materials. Evaluates and interprets laws, rules, and regulations as they apply to various practice acts and related statutes and recommends changes as necessary. Represents the agency at board meetings, probable cause panel meetings, hearings, conferences; attends education seminars to enhance professional development and expertise. Assists as mediator in resolution of complaint issues. Assists with training in use of new forms, reports, procedures according to policy. Performs other duties as required.

Requirements

• Proficient computer skills to include Word, Excel, PowerPoint and Outlook
• knowledge of computer data bases
• knowledge and use of the compliance management system and licensing system used by the Agency
• knowledge of laws, legal codes, court procedures and government rules & regulations
• knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar
• understanding written sentences and paragraphs in work related documents
• communicating effectively with others verbally and in writing
• talking to others to effectively convey information
• ability to establish and maintain effective working relationships with others
• listening to what other people are saying and asking questions as appropriate
• conduct fact-finding research
• knowledge of the methods of data collection and analysis
• organize data into logical format for presentation in reports, documents and other written materials
• knowing how to find information and identifying essential information
• finding ways to structure or classify multiple pieces of information
• ability to plan, organize and prioritize work assignments
• ability to work independently
• ability to maintain a high degree of accuracy and close attention to detail
• effectively manage time
• make sound judgements
• ability to maintain strict confidentiality.

Nice To Haves

• High School Diploma or equivalent
• (2) years of experience to include data entry, case management, reviewing or auditing documents for specific criteria; applying applicable laws, rules, regulations, policies and procedures; researching and gathering data; preparing reports and correspondence.
• College education may substitute for the required experience on a year-for-year basis.
• Must have a valid driver's license, satisfactorily complete a background investigation, fingerprinting, and participation in direct deposit are requirements for employment.

Responsibilities

• Analyzes and processes medical/allied health complaints consisting of Code 15 Reports (Hospital, Nursing Home & Assisted Living Facility), civil malpractice settlements, civil complaints, hospital disciplinary reports, internet prescribing/unlicensed storefront pharmacies and consumer complaints against Florida health care licensees to determine conformity with existing quality assurance principles and standards.
• Consults with federal, state, and local organizations on matters related to the above reports/complaints.
• Interprets and applies statutes, policies, and regulations in analyzing complex data regarding patient care and malpractice issues involving health care practitioners.
• Reviews documents and/or contacts appropriate parties to ensure compliance with applicable statutory and regulatory requirements.
• Conducts investigations when appropriate; issues subpoenas, citations, cease and desist agreements and notices of non-compliance; contacts and interviews witnesses and experts as necessary when conducting investigations; prepares investigative reports and prepares file for legal review; testifies at hearings as necessary.
• Provides technical assistance, consultative services and direction for development, implementation and evaluation of data and reports.
• Researches, prepares, and disseminates reports of a topical or statistical nature as required by management or agency officials.
• Consults with, assists, and acts as liaison between and among the professional boards, complainants, licensees, consultants, other governmental agencies, and the various sections of the agency; assists in the development of consumer education materials.
• Evaluates and interprets laws, rules, and regulations as they apply to various practice acts and related statutes and recommends changes as necessary.
• Represents the agency at board meetings, probable cause panel meetings, hearings, conferences; attends education seminars to enhance professional development and expertise.
• Assists as mediator in resolution of complaint issues.
• Assists with training in use of new forms, reports, procedures according to policy.
• Performs other duties as required.

Benefits

• Annual and Sick Leave benefits
• Nine paid holidays and one Personal Holiday each year
• State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options
• Retirement plan options, including employer contributions (for more information, please click www.myfrs.com)
• Flexible Spending Accounts
• Tuition waivers

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees