Regulatory Compliance Specialist

SUMMARY

Plans and manages regulatory compliance for ElderONE Program of All Inclusive Care for the Elderly (PACE) and Managed Long-Term Care (MLTC) programs. Ensures ElderONE meets or exceeds all regulatory and accreditation requirements. Works in collaboration with the ElderONE leadership team to plan, develop, implement, monitor and measure effective programs and processes that assist ElderONE in achieving its goals and objectives and that adhere to local, state and federal clinical and non- clinical compliance regulations. Monitors and is actively involved with understanding regulatory activity at the state and federal level; informs ElderONE leadership about the interpretation of new regulations and plans for and manages the implementation of changes as needed.

LOCATION: ElderONE- Administrative Office

DEPARTMENT: EO HEALTH PLAN OPERATIONS

SCHEDULE: Monday-Friday (8:00am-4:30pm)

ATTRIBUTES

• 1 year of experience working with a frail or elderly population preferred.

• Experience with Medicare and Medicaid programs.

• Strong communication skills and organizational skills.

• Ability to organize and lead large projects and initiatives across multiple business areas independently.

• Strong orientation to analytics, deadlines and detail.

RESPONSIBILITIES

• Ensures the program complies with all applicable Federal and New York State laws, PACE, Licensed Home Care Services Agencies (LHCSA) and NYSDOH regulations.
  Develops and executes compliance communication tools and training and monitoring programs to ensure ElderONE is surveyed ready every day.

• Assesses potential non-compliance vulnerabilities, identifies root causes of issues and provides practical business recommendations for corrections.

• Works with ElderONE leadership and team members to develop recommendations and reach meaningful and appropriate resolutions.

• Research, interprets and communicates regulation activity, assesses the business impact as a result of state and federal regulations and mandates (existing, new, changing, possible, emerging); provides guidance to ElderONE leadership, works directly with ILS leadership and team members to define and document requirements for implementation and then coordinates with ElderONE leaders and team members to implement the necessary changes.

• Collaborates with leaders to appropriately plan for regulatory reviews, identifies opportunities and leads activities or projects to meet regulatory standards.

• This may include designing or redesigning processes, developing policies and procedures, coordinating communications, coordinating and/or implementing educational programs.

• Survey readiness responsibilities:

• Maintains current knowledge of accreditation and licensure requirements under the PACE, MLTC, LHCSA programs.

• Oversees and assists in assessment and action plans for deficiencies prior to surveys

• Assists ElderONE in resolution of deficiencies by providing strategies that successfully meet the intent of the standard.
  Collaborates with leaders to resolve continued non-compliance with standards.

• Drives performance improvement activities which will achieve compliance with standards.

• Collaborates with leaders to plan and coordinate activities associated with surveys.
  Leads and assists in the development of responses to required action plans as a result of surveys.

• Ensures measurement activities are completed and reported as required following surveys.

• Works with National PACE Association (NPA), various groups/coalitions (e.g. MLTC/PACE Coalition) and reviews applicable 'list serves' to understand legislation and lobbing activities, which may impact decisions on how to maintain compliance, as well as how new PACE programs are added.

• Licensure/Applications/Waivers/Notifications

• Takes lead role in preparing applications, waivers and notifications and related documentation as needed to support strategic goals and objectives.

• Prepares responses for requests for additional information to government agencies;
  Updates licensure, application, waiver, notification information based on guidance from NYSDOH and CMS.

• Tracks status of all licensure, applications, waivers, notifications and manages to completion.

• Works with various subject matter experts to coordinate activity associated with documents noted above based on the business need.

• Prepares for and organizes monthly meetings with CMS and NYSDOH
  Under the guidance of ILS leadership, develops and implements an annual compliance workplan.

EDUCATION:

• BS (Required)

PHYSICAL REQUIREMENTS: S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

PAY RANGE: $63,000.00 - $80,000.00

Salary : $63,000 - $80,000