Regulatory Review Specialist, RN

🕒 Junho 10

🤠 Texas – Remoto

🤠 Texas – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🚔 Conformidade

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VitalCaring Group

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

👥 B2C

🧘 Bem-estar

B2C • Wellness

O VitalCaring Group é um provedor de serviços de saúde domiciliar, incluindo cuidados de saúde em casa e cuidados paliativos, focado em oferecer suporte médico, emocional e espiritual compassivo e personalizado aos pacientes em seus lares. A organização enfatiza a confiança, dignidade e melhora na qualidade de vida dos pacientes—particularmente aqueles com condições crônicas, pós-agudas ou limitantes—e colabora com médicos para criar planos de cuidado individualizados. A VitalCaring também publica notícias e estudos de caso sobre resultados, e tem realizado programas piloto usando IA para melhorar o cuidado cognitivo e reduzir a carga dos cuidadores.

Descrição

• Support payer audits and medical record reviews, ensuring timely and accurate submission of requested documentation • Manage medical review requests and appeals associated with CMS contractors, regulatory agencies, and billing intermediaries • Review clinical documentation using established audit and submission checklists • Partner with operational and clinical teams to gather and validate required records • Participate in chart reviews and compliance monitoring initiatives across the organization • Assist with risk identification activities and regulatory readiness efforts • Support investigations and corrective actions related to compliance findings • Maintain audit tracking and outcomes through documentation systems and reporting tools • Navigate multiple EMRs, payer portals, and operational systems to manage submissions and appeals • Contribute to training and educational materials that strengthen compliance knowledge across teams • Participate in internal quality, billing, and operational review activities • Complete additional regulatory and administrative projects as assigned

🎯 Requisitos

• Current Registered Nurse (RN) license • Minimum 3 years of clinical operational leadership or supervision experience within Home Health and/or Hospice • Strong knowledge of CMS Home Health regulations and state/federal licensing standards • Experience performing clinical chart reviews and documentation audits • Ability to independently prioritize and manage work in a remote environment • Strong technical skills and comfort navigating multiple systems and portals • Excellent communication, organization, and follow-through. • Preferred Experience: Medical review, appeals, audit response, or utilization review experience • Exposure to payer audits and contractor review processes • Experience supporting compliance, quality, accreditation, or regulatory initiatives • Experience with EMR platforms and documentation tracking systems • Background working with billing, reimbursement, or operational compliance functions

🏖️ Benefícios

• Medical, Dental, and Vision coverage • Pharmacy benefits • Virtual care and mental health support • Flexible Spending Accounts (FSA) and Health Savings Account (HSA) • Supplemental health and life insurance • 401(k) with company match • Employee referral program • Prepaid legal services • Identity theft protection • Generous paid time off • Pet insurance • Tuition and continuing education reimbursement