Enforcement Compliance Reviewer

About the role

The Enforcement Compliance Reviewer is responsible for reviewing state licensing violations and certification principle violations for various long-term care programs including Day Activity Health Services (DAHS), Home and Community Support Services Agencies (HCSSA), Individualized Skills and Socialization (ISS), Prescribed Pediatric Extended Care Centers (PPECC), Home and Community-based Services (HCS), and Texas Home Living (TxHmL).

Responsibilities

• Performs review and analysis of state licensing violations for DAHS, HCSSA, ISS, and PPECC.
• Performs review and analysis of state certification principle violations for HCS and TxHmL.
• Implements the Issue, Rule, Application and Conclusion (IRAC) method to determine whether the documented evidence and packets support a determination of noncompliance and whether violations warrant enforcement action.
• Maintains systems for follow-up and tracking of assignments, and performs data entry in applicable program databases including but not limited to TULIP, SharePoint, Access.
• Conducts Informal Dispute Resolution (IDR) reviews of state licensing violations and prepares detailed narrative of rationale and decision.
• Reviews Opportunity to Show Compliance (OSC) packets to determine if the recommended action is warranted and supportable and prepares detailed narrative of rationale and decision.
• Communicates with regional and state office staff to provide consultation, interpretation, guidance, and clarification of DAHS, HCSSA, ISS, PPECC, HCS, and TxHmL standards, principles, and rules.
• Attends enforcement case pre-hearing conferences and hearings related to enforcement actions of DAHS, HCSSA, ISS, PPECC, HCS, and TxHmL.

Requirements

Knowledge of the administration and provision of care under DAHS, HCSSA, ISS, PPECC, and HCS and TxHmL programs or other long-term care programs. Knowledge of Medicare, Medicaid, and/or state licensing rules relating to DAHS, HCSSA, ISS, and PPECC, or other long-term care programs; and/or certification rules relating to HCS and TxHmL programs. Knowledge of regulatory activities including inspections/surveys, investigations, and/or enforcement. Ability to gather, organize, analyze facts; compile and prepare reports; effectively enter and track data, develop and evaluate policies and procedures and initiate modifications as needed. Ability to perform work independently and operate effectively within established guidelines and timeframes. Ability to establish and maintain effective working relationships with managers, team members, internal and external stakeholders. Ability to communicate effectively both orally and in writing. Skill in operating computers and in using computer software.

Qualifications

Graduation from an accredited college or university with a degree in a related field of health care, social services, or legal services. Experience in long-term care regulatory services. Experience in DAHS, HCSSA, ISS, PPECC, HCS or TxHmL programs. Experience in surveys, investigations, or enforcement of long-term care regulatory services. Experience in long term care facilities.

Skills

• Ability to gather, organize, analyze facts; compile and prepare reports; effectively enter and track data, develop and evaluate policies and procedures and initiate modifications as needed.
• Ability to perform work independently and operate effectively within established guidelines and timeframes.
• Ability to establish and maintain effective working relationships with managers, team members, internal and external stakeholders.
• Ability to communicate effectively both orally and in writing.
• Skill in operating computers and in using computer software.