DESCRIPTION:

The Regulatory Specialist, Policies will be responsible for developing, composing, editing, clarifying, and maintaining organizational policies, procedures, regulations, interpretive issuances, and presentations; and ensuring the implementation of new and revised policies and guidelines. The Regulatory Specialist, Policies, will support the department's efforts to track and trend data outcomes, performance improvement initiatives, and staff development needs.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Develop, initiate, maintain, and revise policies and procedures for the general operation of Somatus' compliance program and its related non-compliant activities
• Meet with program managers and other key business owners to acquire a thorough knowledge of each program and/or department operations and procedures
• Responsible for the technical writing of organizational policies and procedures, including as-needed routing and revising policies through existing protocol
• Revise existing manuals, as needed, and maintain records of any policy changes
• Write policies and manuals in line with standards for accreditation, agency contract needs, and ongoing continuous quality improvement
• Research best practices for policies, procedures, and manuals
• Maintain drafts of policies in the existing organizational method
• Responsible for the implementation and monitoring of the organization's quality improvement program
• Ensure processes are in place to monitor and measure all activities related to performance improvement
• Coordinate activities related to clinical record review for data collection
• Compile, trend, and report quality data in the following areas: patient care, safety, risk management, infection control, outcomes, and customer satisfaction
• Partner, collaborate, develop and support the Regulatory Specialists within the Clinical Operations – Quality, Audit, and Risk department as follows:
• Care management and regulatory initiatives
• Create and maintain audit tools and reports
• Assess survey readiness for NCQA accreditation and state and federal-based quality improvement compliance
• QI compliance-related activities are accomplished each year
• Direct compliance issues to appropriate channels for investigation and resolution
• Acquire a thorough knowledge of each program and/or department operations and procedures
• Collect, compile, trend, and report quality data in the following areas: patient care, safety, risk management, infection control, outcomes, and customer satisfaction
• Investigate, manage, and analyze variances, incidents and risk management data
• Comply with risk management-related standards for CMS, NCQA, and other accrediting agencies
• Complete credentialing packages and applications for new and current providers
• Resolve any issues related to provider credentialing

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

REQUIRED EDUCATION & EXPERIENCE:

• Bachelor's degree in Nursing or other related fields
• Two (2) years of experience with policy writing, development, and quality improvement
• Experience in delegated Case and/or Care management
• Experience with Navex Global and/or EthicsPoint
• Experience with NCQA, CMS regulations, and accreditations
• Strong clinical background

KNOWLEDGE, SKILLS, & ABILITIES:

• Possess an intermediate level of knowledge of local, state, and federal laws and regulations on guidelines of provider and/or healthcare care management
• Ability to document and analyze complex business requirements and processes
• Strong analytical skills
• Ability to be both a strategic and tactical change agent in the healthcare space
• Self-starter who will take initiative and be proactive when there are multiple priorities
• Strategic solution-seeker who sees opportunities when others see barriers
• Strong interpersonal skills and ability to communicate effectively
• Ability to handle ambiguity and desire to work in a fast-paced start-up environment
• Detail-oriented, accurate and complete work timely
• Ability to communicate in a courteous and professional manner with teammates, leadership, vendors, and others
• Proficient in MS Word, Excel, and Outlook

TRAVEL REQUIREMENT:

• This position may require up to 10 - 25% travel. Travel may be outside the local area and overnight.

PHSYICAL REQUIREMENTS:

• This job operates in a professional setting. While performing the duties of this job, the employee is regularly required to sit or stand for extended periods. Normal manual dexterity is required.
• Normal speaking and hearing abilities to interact with others in an office environment, over telephone or other video conferencing platform.
• The employee is occasionally required to stand; walk; and reach with hands and arms and continuously repeat the same hand, arm finger motion many times as in typing.

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.

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