Entry Level Utilization Review Remote Jobs in Georgia

Salary: $61,280.00 Annually
Location : Zone 7 Burke, Candler, Columbia, Emanuel, Glascock, Jefferson, Jenkins, Johnson, Richmond, Screven), GA
Job Type: Full-Time Salaried
Remote Employment: Flexible/Hybrid
Job Number: 2022-01746
Division: Healthcare Facility Regulation Division (HFRD)
Unit: Non LTC Surveyor
Opening Date: 11/13/2023
Closing Date: Continuous
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 almost 10 million people. DCH serves as the lead agency for Medicaid and oversees the State Health Benefit Plan (SHBP), Healthcare Facility Regulation and Health Information Technology in Georgia for 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 four program divisions. DCH employees are based in Atlanta, Cordele and across the state.
DCH is currently seeking qualified applicants for the position of Compliance Specialist 2, Long-term Care Unit with Healthcare Facility Regulation Division.This is a home based position located in the Zone 7 (Central Region).
Note: All applicants must reside in one of the following counties of Zone 7:
Burke, Candler, Columbia, Emanuel, Glascock, Jefferson, Jenkins, Johnson, Richmond, Screven, Washington
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. 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. Position requires 90% state wide overnight travel.
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:

• Certification(s) and/or Degree in one or more of the related fields
• Experience as a LPN in the field of home health and/or hospice or hospital
• Experience as a Registered Nurse/LPN in the field of mental health/retardation or Drug Treatment
• Experience in utilization review and/or quality assurance in a healthcare setting
• Experience in conducting assessments and evaluations based on regulations, legal requirements and/or recognized accreditation standards
• Experience in a position in a hospital, psychiatric hospital, ambulatory surgery center, home health or hospice agency, ESRD's or other licensed health care facility
• Demonstrated ability to produce high quality documentation with attention to detail
• Strong communication and writing skills
• Strong organizational and time management skills

Additional Information
Earn more than a salary! In addition to a competitive salary, the Georgia Department of Community Health offers a generous benefits package, which includes employee retirement plan; paid holidays annually; vacation and sick leave; health, dental, vision, legal, disability, accidental death and dismemberment, health and child care spending account.
Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered, but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process. Applicants who are not selected will not receive notification.
THIS POSITION IS SUBJECT TO CLOSE AT ANY TIME ONCE A SATISFACTORY APPLICANT POOL HAS BEEN IDENTIFIED. APPLICATIONS WITHOUT WORK EXPERIENCE LISTED WILL NOT BE CONSIDERED. CURRENT GEORGIA STATE GOVERNMENT EMPLOYEES WILL BE SUBJECT TO STATE PERSONNEL BOARD (SPB) RULE PROVISIONS. THE POSITION MAY BE FILLED AT A LOWER OR HIGHER POSITION LEVEL.
This position is unclassified and employment is at-will. Candidates for this position are subject to a pre-employment background history and reference check.
For more information about this job and other career opportunities with DCH, please visit our Careers Page: .
In addition to a competitive salary, we offer a generous benefits package that includes a flexible schedule, training opportunities, employee retirement plan, deferred compensation, 13 paid holidays, vacation & sick leave, dental, vision, long term care, and life insurance.
01
The answers you provide to the supplemental questions will be used to determine if you meet the minimum qualifications for this position. Your responses pertaining to specific work experience and education must be clearly shown in the areas for work history and education on your application. Your application must be completed in full before it is submitted. We do not accept additional information after your application has been received by the Personnel Department. Do you accept these conditions?

• Yes
• No

02
What is your highest level of education completed?

• Master's Degree
• Bachelor's Degree
• Associates Degree
• Some College/Tech School
• High School Diploma
• GED
• None of the above

03
Are you a current employee of the Georgia Department of Community Health?

• No
• Full Time Employee
• Part Time Employee
• Temp or Contractor
• Intern
• Volunteer

04
Do you have a current Georgia license to practice as a Registered Nurse (RN) or a Licensed Practical Nurse (LPN)?

• Yes, I am a registered nurse (RN) licensed in the State of Georgia.
• Yes, I am a practical nurse (LPN) licensed in the State of Georgia.
• No.

05
How many years of clinical experience do you have in the field of home health, hospice, hospital, nursing home, assisted living, private homecare, adult daycare, or any licensed healthcare facility?

• None
• 1 Yr to less than 2 Yrs
• 2 Yrs to less than 3 Yrs
• 3 Yrs to less than 4 Yrs
• More than 4 Yrs

06
What interest do you have in working as a surveyor in the field of regulatory compliance in a healthcare setting as it relates to your current or most recent work experience?
07
How does your work experience fit the requirements of the role of a surveyor in regulatory compliance in a healthcare setting?
08
This position conducts onsite surveys at healthcare facilities across the State of Georgia and requires statewide travel. Do you agree to extensive statewide travel?

• Yes
• No

09
Are you a US military veteran?

• Yes
• No

Required Question