Compliance Reviewer

Job Description:

Compliance Reviewer – Starting Market Rate Salary $65,556.57

This position can be located anywhere in the state.

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.

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

Essential Job Functions:
Develops and maintains quality assurance tracking systems for quality assurance reviews.
Monitors and tracks survey processes from exit through quality assurance and enforcement reviews.

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 subject matter expert and 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:

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, iQies 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.
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.

Skill in problem solving and decision-making.

Skill in building and maintaining effective work relationships.

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.

May provide professional testimony at hearings.

Experience monitoring compliance with policies and procedures.

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

Registration or Licensure Requirements:
Must possess SMQT qualification

Registered Nurse (RN) Texas licensure preferred.

Initial Selection Criteria:
A Bachelor’s degree from an accredited college or university

A minimum of 2 years’ experience surveying, interpreting, or overseeing compliance with state and federal licensure regulations and standards in Long Term Care facilities required.

Experience identifying, supporting and discussing immediate Jeopardy or Immediate Threat situations preferred

Experience reviewing the work of others and providing professional, constructive feedback to all levels of staff preferred. 

Experience with Licensed Only Facilities (ALF, DAHS, ISS) preferred.