Regulatory Review Specialist

At VitalCaring, we believe every encounter is an opportunity to bring hope, support, and exceptional care to those we serve. Our people live our values - Trustworthy, Capable, Compassionate, Proactive, and Called - and we are committed to creating a culture where purpose and passion thrive. We are seeking a Regulatory Review Specialist who wants more than a role - someone who wants to make a meaningful impact every single day. The primary function of the Regulatory Review Specialist (AC) is to participate with Medical Reviews required as condition of participation under licensing requirements.

Join VitalCaring – Where Your Passion Shapes Purpose

Ready to contribute to work that advances a mission worth standing behind? At VitalCaring, our Home Office teams bring our mission to life by ensuring every patient experience is rooted in trust, compassion, and exceptional support. We are a team of thoughtful and strategic problem-solvers who strengthen the systems that power our vision of being the most trusted, capable, and caring partner in home-based healthcare. Guided by our values, we create an environment where colleagues grow, collaborate, and deliver excellence that uplifts both our teams and the patients we serve.

Who We Are

Founded in 2021, VitalCaring has grown into a leading home health and hospice provider with more than 65 locations across the country. Our corporate teams are the backbone of our mission, ensuring our caregivers in the field have the tools, support, and infrastructure they need to deliver compassionate, high-quality care every day.

Why Join Our Corporate Team?

✓ Shape the Backbone of Our Mission

Bring your expertise to a team that drives strategy, operational excellence, and organizational growth. Your work behind the scenes strengthens the care delivered in homes across the nation.

✓ Innovate, Influence, and Elevate

Support a fast-growing organization where fresh ideas are welcomed, cross-functional collaboration is the norm, and your voice directly contributes to smarter processes, better systems, and a stronger future.

✓ Thrive With a Team That Invests in You

Join colleagues who value partnership, transparency, and continuous improvement. We celebrate progress, share knowledge freely, and work together to advance our mission.

✓ Grow Your Career

Access leadership development, training programs, career-pathing opportunities, and meaningful mentorship designed to elevate your impact.

✓ Competitive Compensation & Comprehensive Benefits

Our benefits package is thoughtfully designed to support your wellbeing and empower you at work and in life, reflecting the value you bring to our organization.

Health & Wellness

• Medical, Dental & Vision
• Pharmacy Benefits
• Virtual & Mental Health Support
• Flexible Spending Accounts (FSAs) & Health Savings Account (HSA)
• Supplemental Health & Life Insurance

Financial & Legal

• 401(k) with Company Match
• Employee Referral Program
• Prepaid Legal Plans
• Identity Theft Protection

Work-Life Balance & Perks

• Paid Time Off
• Pet Insurance
• Tuition & Continuing Education Reimbursement

Join VitalCaring and help us build the systems, solutions, and support that move our mission forward.

Our Regulatory Review Specialists primary functions include, but are not limited to requests from Payers, CMS contractors, licensing bodies, quality assurance organizations, or other government oversight authorities. Function as member of the Clinical Regulatory Compliance (CRC) team following the medical review process for all requests for medical reviews and appeals received from billing intermediaries or audit contractors.

What you will do:

• Participates in Payer source audits including Medical Reviews of records and compiling records for submission to Payers.
• Participates in All Medical reviews for CMS and regulatory contractors. Utilizes documentation checklist to ensure all required items are present.
• Coordinates with Clinical departments regarding documentation requests to ensure timely processing and submission of requests.
• Participates in Medical Reviews for purposes of risk management areas identified by company based on professional standards.
• Participates in a multifaceted educational and training program that focuses on the elements of the organization's compliance program and seeks to ensure that all appropriate employees, agents, and management personnel are knowledgeable of and comply with pertinent federal and state regulations.
• Participates in Quality and Compliance activities to ensure staff are knowledgeable of, and comply with, applicable federal and state laws, standards, and guidelines.
• Participates with chart and billing reviews conducted by both internal and external auditors/consultants.
• Coordinates internal compliance review and monitoring activities of the organization's financial department, including at least annual reviews of departments.
• Participates in investigations into matters surrounding activities as needed based on risk analysis or referrals.
• Assist with the development of training materials and programs.
• Works within all required EMR's, payer /contractor portals to produce and submit all requested reviews and appeals as needed.
• Compiles all required documentation and works in Medical Review Smartsheet for tracking all audits, submissions, outcomes as required within documentation deadlines.
• Completes other clinical and administrative tasks related to Regulatory compliance activities as needed.

What You Bring:

• Education: Nurse, RN
• Experience: Minimum 3 years Clinical operational supervision with home health and/or hospice
• Skills: Knowledge of CMS Home Health regulations including state and federal licensing standards. Experience with Clinical chart review. Must have ability to work independently in remote setting with assigned duties. Have computer skills and ability to learn navigation of various EMR, Payer portals and Operational databases to comply with documentation requirements. Demonstrate excellent interpersonal and organizational skills.

Additional Qualifications:

• Prolonged sitting required, with the ability to operate office equipment which may include heavy lifting, bending, and standing.
• Requires ability to use up to 50 pounds of force occasionally and/or up to 20 pounds of force frequently and/or up to 10 pounds continuously to move objects.
• Requires ability to grasp, pull, push, carry or otherwise manipulate objects; ability to perform tasks requiring action of muscles or groups of muscles and foot and/or hand-eye coordination.
• Work deals mostly with areas such as preparing and reading data and figures, records, reports, visual inspection involving small details. Although important, depth perception and field of vision (peripheral) are not as critical as the ability to distinguish small details and markings near to the observer.
• Position requires sitting approximately 60% of time standing/stooping/bending/ climbing approximately 20% of time; and walking approximately 20% of time.
• Requires ability to concentrate on fine detail with frequent interruption; ability to focus attention on tasks for 10-20 minutes at a time on a continuous basis, 20-60 minutes on occasion.
• Requires the ability to remain calm and courteous under stress.
• Requires working under strict turnaround time guidelines to meet business needs.
• Requires ability to communicate clearly and make self-understood effectively in face-to-face interactions; articulate with accuracy to communicate using phone.
• Requires ability to hear and receive verbal instructions correctly, answer phones, communicate professionally in situations with some background noise.
• Requires ability to understand and relate to specific ideas one at a time and to the concepts behind specific ideas; ability to remember verbal and written tasks/assignments from a few hours to several day periods.
• Excellent computer software skills necessary to produce accurate documents and materials required.
• Working knowledge of MS Office, Excel or similar software required. Proficient knowledge preferred.
• Requires ability to work effectively under minimal supervision; exercise excellent, sound professional judgment and maintain confidentiality.
• Must have and maintain a valid Driver's License, and proof of current valid auto liability insurance.