Regulatory Review Specialist, RN

🕒 il y a 14 jours

🤠 Texas – Distant

🤠 Texas – Remote

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

🚔 Conformité

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VitalCaring Group

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1001 - 5000 employés

👥 B2C

🧘 Bien-être

B2C • Wellness

Le Groupe VitalCaring est un fournisseur de services de santé à domicile, incluant les soins à domicile et palliatifs, se concentrant sur la fourniture d'un soutien médical, émotionnel et spirituel compatissant et personnalisé aux patients dans leur domicile. L'organisation met l'accent sur la confiance, la dignité et l'amélioration de la qualité de vie des patients, en particulier ceux souffrant de conditions chroniques, post-aiguës ou limitatives de vie, et collabore avec des médecins pour créer des plans de soins individualisés. VitalCaring publie également des actualités et études de cas sur les résultats obtenus, et a mis en place des programmes pilotes utilisant l'IA pour améliorer les soins cognitifs et réduire la charge des aidants.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

• 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