Complnc Specialist 1

Under supervision, may plan, organize, or coordinate the activities of an assigned program. Learns to review, monitor and ensure 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. Receives additional training, as required, to gain full proficiency and experience in all areas

Must have a valid driver's license, able to successfully complete a National Agency Check with Inquiries (NAC-I) and fingerprints to obtain a Personal Identity Verification (PIV) card issued by the Department of Veterans Affairs. This condition of employment may not be waived. Failure to obtain a PIV card will result in immediate termination of employment.