Quality Assurance Compliance Reviewer

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.

Brief Job Description: 

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! 

Compliance Reviewer – Starting Market Rate Salary $68,834.43 

Under the supervision of the Quality Assurance Regional Programs Manager, the Compliance Reviewer reviews and provides corrections for deficiencies and violations written across the state for regulated programs such as Nursing Facilities (NF). This position conducts reviews and makes state and federal quality assurance recommendations. The Compliance Reviewer provides consultation and guidance in development and revision of NF statewide quality assurance related policies. The Compliance Reviewer provides professional regulatory feedback to surveyors, program managers, other state office level program staff. May assist Quality Assurance and Program Integrity leadership in regulatory decision-making.  

This position may communicate with Center for Medicare and Medicaid Services (CMS) related to enforcement. The Compliance Reviewer communicates with internal staff to ensure consistency of quality assurance information. May be a witness at hearings. Participates in work groups, committees, and meetings as the quality assurance representative. Reviews certification, licensure, and all other long-term care onsite visit reports for compliance with state laws, regulations, and policies and procedures. Assures reports follow established protocols and are accurately documented. Reviews and verifies information documents and data entry performed by others. Participates in review committees, prepares analysis of data for review and identification of staff training needs. Assists the Quality Assurance Regional Programs Manager with other tasks as needed or directed. 

This position offers a competitive starting salary; excellent state benefits, including health insurance and retirement. 

To watch a brief video showing the vital work long-term care surveyors do every day, please click here: https://www.youtube.com/watch?v=OSfRR_lU23s=_blank>Link Title 

The state of Texas offers many benefits to employees. HHSC is a qualifying organization for the Federal Public Service Loan Forgiveness Program, which forgives the remaining balance on college student Direct Loans after making 120 qualifying monthly payments. We also offer excellent health benefits, a lifetime monthly retirement annuityas well as 401(k) and 457 Programs under the Employees Retirement System of Texas. 

Essential Job Functions (EJFs): 

Develops and maintains quality assurance tracking systems for quality assurance reviews. 
Monitors and tracks survey processes from exit through quality assurance and enforcement reviews to include notifications to the facilities. 

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 the assigned scope and severity. 
Makes state and federal quality assurance recommendations. 
Provides consultation and guidance in the development and revision of facilities regional enforcement related guidance. 
Provides guidance to regions and state office regulatory staff on enforcement issues by interpreting policies, regulations, rules and state and federal guidance letters.  

May participate in enforcement reviews. 
Provides clarification to regional staff to ensure strength of future deficiencies resulting in remedies being imposed.  

Communications with Center for Medicare and Medicaid Services (CMS) for directives and guidance related to specific enforcement cases. 
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 nursing facility quality assurance representative. May be required to develop and facilitate presentations related to data trends, quality assurance and consistency. 

May be a witness at hearings. 
Responds to management, media, and legislative inquiries as appropriate. 
Compiles monthly reports of quality assurance activities noting patterns and trends.  

Knowledge, Skills and Abilities (KSAs): 

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 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. 

Skill in problem solving and decision-making. 

Skill in building and maintaining effective work relationships. 

Experience monitoring compliance with policies and procedures. 

Experience planning, implementing, coordinating, monitoring, and evaluating policies and procedures. 

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 interpret policies, procedures, and regulations. 
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. 

Ability to plan and direct program activities to support agency goals. 

Ability to communicate with others to provide, exchange, or verify information, answer inquiries, address issues, or resolve problems or complaints. 

Ability to effectively interact with others in political/stressful situations. 

Registrations, Licensure Requirements or Certifications: 

Must have Surveyor Minimum Qualifications Test (SMQT) Certification. 

Initial Screening Criteria: 

A Bachelor’s degree from an accredited college or university in a human service field (including but not limited to sociology, education, social work, psychology, rehabilitation, counseling, humanities, allied health, behavioral science, early childhood intervention, and medical administration) is preferred but not required.   
Experience interpreting or overseeing compliance with state and federal licensure regulations and standards preferred. 
Work experience in regulated facilities, including regulatory services, is preferred. 

Experience in any Long-Term Care Regulatory program. (Skilled Nursing Facilities) 

Additional Information: 

Flexibility in work hours is required for this position. The job requires 30% travel, with most travel during the day. However, some overnight and weekend travel is required, as well as occasional on-call duties for emergencies or high-priority situations. Must have reliable transportation.  

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the online application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need an accommodation to participate in the interview process, please notify the person scheduling the interview. 

All applicants must pass a fingerprint criminal background check. 

If you are an active or former licensed nursing facility administrator, certified nurse aide, or medication aide, hiring will be pending until professional licensing and Employee Misconduct Registry checks are completed. 

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work. I-9 Form - Click here to download the I-9 form. 

Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.

Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.