Compliance Specialist 2

Description Pay Grade : L

The Georgia Department of Community Health (DCH) is one of Georgia's four health agencies serving the state's growing population of over 10 million people. DCH serves as the lead agency for Medicaid, oversees the State Health Benefit Plan (SHBP) and Healthcare Facility Regulation, impacting one in four Georgians.

Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and under-served populations. Six enterprise offices support the work of the agency’s three program divisions. DCH employees are based in Atlanta, Cordele and across the state.

DCH is committed to providing superior C ustomer Service and C ommunication, embracing T eamwork and fostering A ccountability to ensure that our internal and external customers and stakeholders feel included, respected, engaged and secure.

DCH is currently seeking qualified applicants for the position for Compliance Specialist 2 position with Healthcare Facility Regulation Division. This position will document and conduct on-site surveys and require regional travel. Regional travel may require up to 90% overnight travel. Occasional weekend and after-hours work may also be required.

This is a home based position located in the (Central Region). Note : All applicants must reside in one of the Zone 9 following counties : Bibb, Bleckley, Crawford, Houston, Laurens, Montgomery, Peach, Pulaski, Toombs, Treutlen, Wheeler, Wilkinson Job Responsibilities Under general supervision, may plan, organize or coordinate the activities of an assigned program. Reviews, monitors and ensures compliance with assigned program area's policies and procedures. Conducts on-site reviews, audits or surveys of clinical and treatment facilities, regulated entity operations and program management.

• Conducts utilization reviews, peer reviews, evaluation activities and all other reviews on a scheduled basis.
• Coordinates investigations involving noncompliance in facilities, community programs, regulated entity operations and other related programs.
• Coordinates the data management and quality assurance functions.
• Determines compliance with applicable state and / or federal rules and regulations.
• Develops, implements and evaluates the surveillance of utilization review process to ensure quality services.
• Monitors, tracks, and maintain records on compliance.
• Plans and evaluates outcome studies and / or compliance findings.
• Plans, develops, schedules and implements surveys and complaint investigations for licensure or certification of regulated facilities.
• Plans, organizes, and directs the certification / licensing process.
• Recommends programmatic and / or operational changes based on review, audit or survey results.
• Reviews new rules and service site applications.
• Researches and analyzes state codes, federal regulations and industry manuals regarding forms, policies and procedures.
• Reviews applications for accuracy and compliance with guidelines, regulations and laws. Performs investigations and / or audits according to established rules, regulations and other statutes.

Minimum Qualifications Master's degree in a related field from an accredited college or university OR Bachelor's degree in a related field from an accredited college or university AND Two years of related experience OR Associate's degree in a related field from an accredited college or university AND Three years of related experience OR Four years of related professional experience. Note : Some positions may require a certification or licensure.

Note : Possession of a valid Georgia driver's license, which would enable the applicant to drive in Georgia, and use of a car at work, are required for employees in this job.

PREFERRED QUALIFICATIONS : Preference will be given to candidates, who have a healthcare background and in addition to meeting the qualifications listed above, possess the following :

Experience as as a Registered Nurse / LPN, or licensed professional in a healthcare setting.