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Description:

Trinity Health PACE is seeking a Regional Regulatory Compliance Specialist to join our team.

This remote position will typically work Mon - Fri 8 am to 5 pm Eastern time.

The Program of All-Inclusive Care for the Elderly (PACE) model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.

PACE serves individuals who are age 55 or older, certified by their state to need nursing home care, able to live safely in the community at the time of enrollment, and live in a PACE service area.While all PACE participants must be certified to need nursing home care to enroll in PACE, only about 7 percent of PACE participants nationally reside in a nursing home. If a PACE enrollee needs nursing home care, the PACE program pays for it and continues to coordinatethe enrollee'scare. We encourage fellowship and independence while serving seniors and their families with dignity and respect.

Trinity Health PACE provides a competitive compensation and benefit package that complements this opportunity for personal growth and professional advancement. This position reports to the National Director of Quality Improvement & Compliance.

The Regional Regulatory Compliance Specialist will function as a subject matter expert resource within the assigned Region for the PACE program locations’ compliance with PACE regulatory, OSHA and HIPAA requirements; ensuring through auditing, reporting, education and consultation, guidance and oversight that the highest level of compliance is achieved at all times .

General responsibilities will include (not an exhaustive list):

Conduct routine audits to demonstrate performance on all elements of compliance in the following areas: Participant assessments, Service Determination Requests (SDRs), Appeals, Grievances, and Provision of Services

Collaborate with Human Resource team to ensure upkeep and auditing of personnel regulatory requirements.

Monitor reports for tracking of completion of all services ordered or care planned and perform appropriate sample chart audits on a routine basis .

Perform reviews for potential gaps in identification of SDRs or Grievances through review of reports such as On Call log, and through sample chart audits.

Advise and support local PACE program locations on all required onsite audits of contracted providers and PO privacy/safety rounding, review and track completion of rounding reports . Remote auditing of contracted providers to be performed in support of PO teams .

Candidates will have:

Must possess a comprehensive knowledge of PACE regulations, OSHA requirements, HIPAA rules, and a strong understanding of sampling/auditing methodology as normally obtained through a Bachelor’s degree in a healthcare related field and 2 years of healthcare (PACE preferred) experience. A combination of education and experience may be acceptable.

Experience with auditing and implementing solutions based on findings

Excellent organizational skills. Ability to perform multiple duties and functions related to daily operations and maintain excellent customer service skills.

Candidates should also possess the ability to work as part of a team.

Occasional travel may be required - up to 25% within geographic region.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.