JOB TITLE: Regulatory Compliance Specialist

DEPARTMENT: Regulatory Compliance & Audit

LOCATION: ElderONE Admin-330 Monroe Avenue 2nd Floor Rochester, NY 14607 (Occasional travel to Elderone location as needed for audits and reporting)

HOURS PER WEEK: 40

SCHEDULE: Monday-Friday 8:00am-4:30pm

Position Summary:

Plans and manages regulatory compliance for ElderONE Program of All Inclusive Care for the Elderly (PACE) and Managed Long Term Care (MLTC) programs. Ensures ElderONE meets or exceeds all regulatory and accreditation requirements. Works in collaboration with the ElderONE leadership team to plan, develop, implement, monitor and measure effective programs and processes that assist ElderONE in achieving its goals and objectives and that adhere to local, state and federal clinical and non- clinical compliance regulations. Monitors and is actively involved with understanding regulatory activity at the state and federal level; informs ElderONE leadership about the interpretation of new regulations and plans for and manages the implementation of changes as needed.

Key Responsibilities:

Ensures the program complies with all applicable Federal and New York State laws, PACE, Licensed Home Care Services Agencies (LHCSA) and NYSDOH regulations

Develops and executes compliance communication tools and training and monitoring programs to ensure ElderONE is Survey Ready Every Day. Assesses potential non-compliance vulnerabilities, identifies root causes of issues and provides practical business recommendations for corrections. Works with ElderONEleadership and team members to develop recommendations and reach meaningful and appropriate resolutions

Oversees the periodic review and updating of policies and procedures, obtains the appropriate approvals.

Researches, interprets and communicates regulation activity, assesses the business impact as a result of state and federal regulations and mandates (existing, new, changing, possible, emerging); provides guidance to ElderONE leadership, works directly with ILS leadership and team members to define and document requirements for implementation and then coordinates with ElderONE leaders and team members to implement the necessary changes.

Collaborates with leaders to appropriately plan for regulatory reviews, identifies opportunities and leads activities or projects to meet regulatory standards. This may include designing or redesigning processes, developing policies and procedures, coordinating communications, coordinating and/or implementing educational programs.

Survey readiness responsibilities:

•Maintains current knowledge of accreditation and licensure requirements under the PACE, MLTC, LHCSA programs

•Oversees and assists in assessment and action plans for deficiencies prior to surveys

•Assists ElderONE in resolution of deficiencies by providing strategies that successfully meet the intent of the standard

•Collaborates with leaders to resolve continued non-compliance with standards

•Drives performance improvement activities which will achieve compliance with standards

•Collaborates with leaders to plan and coordinate activities associated with surveys

•Leads and assists in the development of responses to required action plans as a result of surveys

•Ensures measurement activities are completed and reported as required following surveys

•Works with National PACE Association (NPA), various groups/coalitions (e.g. MLTC/PACE Coalition) and reviews applicable 'list serves' to understand legislation and lobbing activities, which may impact decisions on how to maintain compliance, as well as how new PACE programs are added

Licensure/Applications/Waivers/Notifications

•Takes lead role in preparing applications, waivers and notifications and related documentation as needed to support strategic goals and objectives;

•Prepares responses for requests for additional information to government agencies;

•Updates licensure, application, waiver, notification information based on guidance from NYSDOH and CMS;

•Tracks status of all licensure, applications, waivers, notifications and manages to completion;

•Works with various subject matter experts to coordinate activity associated with documents noted above based on the business need.

Prepares for and organizes monthly meetings with CMS and NYSDOH

Under the guidance of ILS leadership, develops and implements an annual compliance workplan.

Desired Attributes:

1 year of experience working with a frail or elderly population preferred.

•Experience with Medicare and Medicaid programs

•Strong communication skills and organizational skills

•Ability to organize and lead large projects and initiatives across multiple business areas independently

•Strong orientation to analytics, deadlines and detail.

Minimum Qualifications:

•Bachelors degree required, Masters preferred

•Minimum three years prior experience working in compliance, regulatory affairs or quality/performance improvement

Required Licensure/Certification Skills

•None

Rochester General Health System is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran

EDUCATION:

BS (Required)

LICENSES / CERTIFICATIONS: 

PHYSICAL REQUIREMENTS:

Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$70,000.00 - $95,000.00Rochester14607

The posted pay range is a good faith representation of potential base pay for this position. It may be modified in the future and eligible for additional pay components. Individual annual salaries/hourly rates could vary based on position details and FTE. Pay is determined by considering factors including, but not limited to, experience, relevant qualifications, specialty, internal equity, locations, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.