Job Description

Job Title: Director, Regulatory & Compliance (RN - Home Health)
Job ID: 689195
Status: Full-Time
Regular/Temporary: Regular
Hours: Daylight, Monday thru Friday
Shift: Day Job
Facility: UPMC Community Provider Svcs
Department: Comm Provider Svcs Admin
Location: 3600 Forbes Ave, Pittsburgh PA 15213

Description

Are you an experienced home health nurse with a passion for compliance and regulatory guidelines? Are you seeking the perfect opportunity to advance your career? Consider this opening supporting UPMC Home Health!

UPMC Community Provider Services is seeking a full-time Director of Regulatory & Compliance to manage all aspects of the Ethics, Compliance & Privacy, Utilization Review, and Audit Management Programs for UPMC Home Health.

Together with the Vice President, Compliance & Quality, you will provide support and direction in the above areas to all UPMC in-home services. This includes, but is not limited to, internal and external audit reviews, internal and external utilization reviews, ongoing risk assessments, education/training programs, agency reviews, regulatory reviews, HIPAA compliance, issuing advice and opinions, policies and procedures management, and coordinating all related activities throughout the organization.

Additionally, the position prepares all reports, as required by the Ethics & Compliance Programs, and is responsible for reporting on all compliance activities to the Vice President, Compliance & Quality as well as the UPMC Home Health Board of Directors. The incumbent will coordinate functions with the Director, Quality and Risk Management and supervise Compliance Specialists as needed.

Are you interested? Apply today!

Responsibilities:
  • Assists the Vice President, Compliance & Quality and other management personnel with resolving operational issues, conducting investigations, completing required analyses, and other activities as required.
  • Assists the Vice President, Compliance & Quality in the developing and monitoring of the annual compliance work plan.
  • Assists with developing, monitoring and reviewing policies and procedures to support compliance and privacy related activities.
  • Coordinates and facilitates the work of compliance specialist staff, as well as billing and clinical staff, as needed.
  • Directs, manages, and performs the mock surveys, and prepares associated reports to ensure compliance with CMS, State, and TJC regulations.
  • Effectively communicates and supports the values of UPMC Home Healthcare and UPMC to all employees.
  • Ensures that education and training programs (new employee orientation, periodic, and annual) related to the Ethics & Compliance and Privacy Programs, as well as specific compliance related topics, are planned, developed, and conducted throughout the organization.
  • Establishes monitoring mechanisms and conducts routine audits of the Ethics & Compliance and Privacy Programs.
  • Independently pursues professional growth and development related to this position and aligned with the mission of UPMC Home Healthcare and UPMC. Participates in community education and/or continuing education programs sponsored by the organization as requested.
  • Maintains, reviews, and updates UPMC Home Healthcare Administrative policies and procedures manual to assure compliance with all regulatory requirements in home health care.
  • Manages the UPMC Home Healthcare & Compliance Program to achieve compliance with regulations, rules and standards of conduct throughout the organization.
  • Manages the UPMC Home Healthcare HIPAA Privacy & Security Program to achieve compliance with regulations, rules and standards of conduct throughout the organization.
  • Oversees and directs the development and maintenance of a system to standardize documentation that facilitates compliance with quality standards, as well as with the guidelines and regulations of governing agencies and third party payers.
  • Oversees and ensures the delivery of the comprehensive annual employee Mandatory Education & Training (MET) drive, which includes several learning modules as well as other HIPAA and Safety related activities.
  • Prepares all Program Reports and distributes on a monthly, quarterly, or annual basis as required by the Programs.
  • Serves as a member of the UPMC Home Healthcare Corporate Compliance Committee and participates in other groups, committees or task forces, as needed.
  • Serves as the Compliance Officer and Privacy Officer in compliance with responsibilities delineated in the UPMC Compliance Officer and Privacy Officer Agenda.

Qualifications

  • Bachelors degree in nursing or health related field required
  • Masters degree in Nursing or related health care field required, either at time of hire/transfer, or must be enrolled in a program within one (1) year of hire/transfer date and successfully completed within three (3) years of enrollment date.
  • Minimum of five (5) years of progressively responsible experience in health care including supervision and leadership
  • Experience in compliance, regulatory and Utilization Management.
  • Superior interpersonal and oral and written communication skills
Licensure, Certifications, and Clearances:
  • Act 34 Criminal Clearance
  • Automotive Insurance
  • Driver's License
  • Registered Nurse
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $0 to $0

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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