Regulatory Compliance Specialist

4 weeks ago

Roseville, California, United States PACS Full time

Job Summary:

PACS is seeking a highly skilled Regulatory Compliance Specialist to join our team. As a key member of our team, you will be responsible for providing oversight on facilities' weekly PDPM meetings for skilled patients.

Key Responsibilities:

  • Tracks and monitors facility effective utilization of PDPM tools, including Physician Diagnosis Verification, Admission/Discharge CSR, Weekly CSR, PDPM Weekly Tracking Tool, and Point Right.
  • Tracks and monitors QM and QASP performance monthly and quarterly, providing data analysis and clinical recommendations for facility optimization.
  • Provides PDPM and MDS training to new MDS Coordinators.
  • Assesses and determines the health status and level of care of all new admissions.
  • Ensures accurate and timely completion of all MDS Assessments, including PPS Medicare, quarterly, and annual assessments.
  • Communicates level of care for new residents to all disciplines.
  • Coordinates interdisciplinary participation in completing the Minimum Data Set (MDS) for each new admission according to regulatory time frames.
  • Maintains an accurate schedule of all MDS assessments, including proper reference dates throughout the resident's stay.
  • Responsible for data entry functions to ensure accurate data entry and electronic submission of MDS assessments.
  • Verifies electronic submissions of MDS, performs corrections when necessary, and maintains appropriate records.
  • Coordinates interdisciplinary participation in completing the MDS for each resident according to regulatory time frames.
  • Ensures completeness and thoroughness of documentation as mandated by federal and state standards.
  • Schedules and conducts resident care conferences in compliance with state and federal regulations, ensuring completion of all MDS reviews prior to resident care conferences.
  • Assists disciplines in formulating and revising care plans.
  • Ensures that resident's present/potential problems are identified and prioritized, realistic goals are established, and nursing intervention is appropriate.
  • Evaluates resident care plans for comprehensiveness and individuality.
  • Assesses the achievement or lack of achievement of desired outcomes.
  • Ensures that resident's care plan is reassessed and revised appropriately.
  • Responsible for all level of care changes within the facility.
  • Notifies all departments when a level of care change has been made.
  • Generates appropriate forms to complete level of acuity and changes.
  • Transmits forms to the appropriate agency for processing as required by state law.
  • Maintains the confidentiality of all resident care information, including protected health information.

Requirements:

  • Graduation from an Accredited School of Nursing with a Bachelor of Science Degree in Nursing preferred.
  • Must be in good standing with the State Board of Nursing and maintain all required continuing education/licensing requirements.
  • 3 years of supervisory experience preferred.
  • Long Term Care Experience Preferred.

Language Skills:

  • Must possess the ability to make independent decisions, to follow instructions, and to accept constructive criticism.
  • Ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the public.

Mathematical Skills:

  • Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Reasoning Ability:

  • Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
  • Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Certificates, Licenses, Registrations:

  • To perform this job successfully, an individual must be proficient in the Microsoft Suite products.
  • Knowledge and experience with PCC preferred.
  • Must maintain all required continuing education/licensing.
  • Must remain in good standing with the State Board of Nursing at all times.

Physical Demands:

  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • The employee must occasionally lift and/or move up to 25 pounds.
  • Prolonged use of a desktop or laptop computer.

Work Environment:

  • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • The noise level in the work environment is typically low to moderate.

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