Clinical Regulatory Specialist

Clinical Regulatory Specialist

Identifies regulatory issues and changes and determines impact on agency (Homecare and Hospice) and/or corporate operations. Develops, implements and revises appropriate policies, procedures, care standards, programs and tools, providing education to home health and hospice agencies and corporate departments. Provides professional regulatory consultation, education, and direction. Assesses agencies’ continuing compliance with the Conditions of Participation and other requirements to be prepared for survey for licensure or certification, and makes recommendations.
Provides agency regulatory survey support, reviewing and making recommendations for responses of required corrective action plans, and for implementation of process changes to carry out the plans. Identifies need for, develops and revises forms/software and other instruments to meet agency regulatory reimbursement and documentation needs. Manages the clinical application of the agency/corporate computer system. Develops and revises training materials and processes for agency computer system; coordinates and provides ongoing education and related material. Participates in periodic agency site visits or mock surveys to review documentation, client assessment and care planning, and care delivery process. Recommends to agency administrators and corporate managers process changes to agency operations to improve compliance with regulations in client care and to improve clinical processes. Provides guidance to agency managers in compliance with payor requirements, analyzing reasons for medical review, and in responding with appeals to claim denials. Provides regulatory expertise when participating in assessments on corporate development/operations projects as requested or needed.
REQUIREMENTS
Minimal Qualifications:
Current Registered Nurse ( RN ) with a valid state license and/or subject to registration in the state where practice/consulting occurs and a Bachelor’s Degree in Nursing minimum. Previous management and operational experience preferred or previous experience as a regulatory specialist. Five years experience in progressive responsibility in health care delivery related to homecare, hospice, acute care, rehab nursing, special projects, supervision, management, hospital, and teaching. Effective communication, problem solving and decision support through a team spirit. Strong and effective verbal and written communication skills. Extensive knowledge of federal and state homecare and hospice regulations/standards. Ability to develop new process methods and principles, and willingness to facilitate incorporation into existing practices. Understanding of OASIS preparation and relationship to reimbursement. Ability to consistently demonstrate commitment to the mission and Business Code of Ethics, and adhere to the Organizational Integrity Program. Travel is required 30% of the time, Hours- M-F 8-5. Pay rate is negotiable.

Excellent Pay Plan and Benefits Available!