Compliance Reviewer

Texas Health and Human Services Commission (HHSC) is committed to creating a positive impact in the lives of fellow Texans. The Compliance Reviewer will review certification and licensure forms for compliance and participate in review committees while also analyzing provider investigation reports and trends.

Responsibilities

• 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

Skills

• 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)
• Experience in interpreting state rules and regulations for LOF required
• 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
• Ability to travel up to 45% (i.e., monthly) for activities such as out of town meetings, trainings sessions or to conduct survey activities as needed
• 18 months preferred 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)
• Provider Investigations experience preferred
• Graduation from a four-year accredited college or university

Benefits

• 100% paid employee health insurance for full-time eligible employees
• Defined benefit pension plan
• Generous time off benefits
• Numerous opportunities for career advancement

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