PRIMARY FUNCTION: The Compliance Nurse is responsible for ensuring that the community complies with relevant regulations and laws governing its operations. This includes monitoring and overseeing the Elderly and Persons with Physical Disabilities (EDP) Waiver renewal process, auditing billing practices, attending required trainings, and ensuring the accuracy and completeness of various reports, requirements, and documentation. The Compliance Director plays a key role in maintaining the organization's compliance with regulatory requirements and promoting a culture of ethical conduct.

TYPICAL RESPONSIBILITIES/DUTIES: The Compliance Nurse’s typical responsibilities and duties include, but are not limited to the following:

§Monitor the EDP Waiver renewal process accurately and timely:

oReview the renewal process for beneficiaries after the Social Services Director follows up with Case Managers monthly to verify beneficiaries’ expiration dates.

oEnsure EPD Waiver Application is submitted.

oEnsure the Electronic Prescription Order Forms (EPOF) is signed, submitted, and uploaded to the DC Care Connect system.

oEnsure that Liberty Assessments are scheduled timely by Case Managers/Social Services Director.

oMonitor Person-Centered Service Plans (PCSP) to ensure they are up to date for every beneficiary within PointClickCare (PCC).

§Audit daily census report to confirm billing is accurate. Settle any discrepancies discovered and work with the Business Office Manager to correct as necessary.

§Audit Billing Spreadsheet to ensure billing has been done appropriately.

§Attend Department of Health Care Finance (DHCF) trainings.

§Audit all staffing in-service trainings to ensure compliance is met. Report findings to the Executive Director and Health Services Director (HSD) to correct if necessary.

§Verify Department of Health (DOH) & DHCF Binders are up to date monthly. This should include:

oDaily Census Reports.

oMonthly DOH Reportable & Serious Incident Reports.

oDC Care Connect & UHC Incident Reports.

oInvestigation Notes.

oRelias Transcripts.

oNew Move-In Leases. 

§New Employee Information.

oNotice to Vacate Forms.

oPersinak Centered Service plans (PCSP’s). o Individualized Services Plans (ISP’s).

oHealth & Physical (H&P) Forms. o Provider Forms.

oRelias Transcripts.

oResident Grievances and Investigation Forms.

oThe DC Ombudsman meetings and trainings documentation.

oActivity Logs and Refusals.

§Monitor Provider Choice Form for each beneficiary within PCC to ensure accuracy and completion. Required to obtain missing information timely and accurately.

§Monitor and update the “Employee Tickler” tracker to verify all required evaluation documentation has been obtained per the DOH requirements. Must notify department heads when reviews are due and obtain completed forms from managers for recordkeeping.

§Audit Billing Spreadsheet to ensure that the Business Office Manager is billing accordingly, accurately, and timely to the Daily Census and fee schedule rate.

§Exercise professional judgment and carefully adhere to all written standards, and personnel administration policies and procedures. Accurately and completely document all matters related to personnel administration.

§Adhere to confidentialitiy standards at the highest level.

EXPERIENCE/EDUCATION:

§Bachelor’s Degree required.

§Minimum 2-3 years of experience in compliance and finance in a healthcare setting.

§Proficiency in MS Office Suite (Word, Excel, Outlook, etc.) along with software and web-based programs.

§Strong organizational, proofreading, and multitasking abilities.

§Excellent verbal and written communication & conflict resolution skills.

§Strong analytical and problem-solving skills.

§Excellent interpersonal skills with all levels of staff, residents, families, and the public.

§Ability to work as a positive team member.

WORKING CONDITIONS: While performing the duties of this job, the employee is frequently or occasionally required to:

§Will sit for extended periods of time. Push, pull, and lift at least 30 pounds regularly. Occasionally will crouch or kneel to access office equipment.