HCSSA Compliance Reviewer

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Job Description:

Compliance Reviewer – Starting Market Rate Salary $68,834.43

This position’s headquarters can be located in any available HHSC LTCR office in the state of Texas.

Under the supervision of the Quality Assurance Regional Programs (QARP) Manager, the QARP Compliance Reviewer (CR) reviews certification and licensure forms that resulted in a deficient practice for Home and Community Support Services Agencies (HCSSA). The QARP CR participates in review committees, prepares data for review, and assists in identifying regional trends and patterns.

Performs advanced technical and professional reviews of certification surveys, licensure inspections, and investigations conducted in long term care facilities to determine compliance with state/federal requirements and protocols, and Long-Term Care-Regulatory (LTCR) policies and procedures. Transforms qualitative data into quantitative data and assists with in-depth analysis of qualitative and quantitative program-specific data. Interprets statistical evidence and develops work plans, reports, and documentary support for program development and assessment.

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.

Essential Job Functions:
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. Consults with regional surveyors, program managers, and other regional staff to clarify any discrepancies and works with the regional staff to recommend appropriate corrections. Assists in compiling of data to show trends resulting from the QA review. Provides ongoing education, both onsite and virtually, to surveyors and regional management. 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. 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. 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. 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.

Knowledge Skills Abilities:
Knowledge of any specialized program area in Long-term Care Regulatory. Knowledge of the principles and methods of field inspection, investigation, or quality control from any program area (HCSSA preferred). Skilled in conducting investigations and determining proper courses of action. Skill in using Microsoft Office software: Word, Excel, and Outlook. Ability to work in a professional team environment; Ability to organize workloads and set priorities to meet deadlines and function with minimal supervision; Ability to prepare concise reports.

Registration or Licensure Requirements:
Registration or licensure in a health care related field preferred. Licensed Registered Nurse preferred. SMQT preferred.

Initial Selection Criteria:
Experience in any Long-Term Care Regulatory program. (Home Health, ICF/IID, Health Facilities, HCS and TxHmL Waiver Programs, or Assisted Living Facilities) HCSSA Programs Preferred. Bachelor’s Degree in a Human or Social Services Field.

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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