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Regulatory Review Specialist, RN
VitalCaring GroupRegulatory Review Specialist managing clinical compliance and documentation for home health services. Ensuring quality outcomes and supporting regulatory readiness in a remote environment.
About the role
Key responsibilities & impact- Support payer audits and medical record reviews, ensuring timely and accurate submission of requested documentation
- Manage medical review requests and appeals associated with CMS contractors, regulatory agencies, and billing intermediaries
- Review clinical documentation using established audit and submission checklists
- Partner with operational and clinical teams to gather and validate required records
- Participate in chart reviews and compliance monitoring initiatives across the organization
- Assist with risk identification activities and regulatory readiness efforts
- Support investigations and corrective actions related to compliance findings
- Maintain audit tracking and outcomes through documentation systems and reporting tools
- Navigate multiple EMRs, payer portals, and operational systems to manage submissions and appeals
- Contribute to training and educational materials that strengthen compliance knowledge across teams
- Participate in internal quality, billing, and operational review activities
- Complete additional regulatory and administrative projects as assigned
Requirements
What you’ll need- Current Registered Nurse (RN) license
- Minimum 3 years of clinical operational leadership or supervision experience within Home Health and/or Hospice
- Strong knowledge of CMS Home Health regulations and state/federal licensing standards
- Experience performing clinical chart reviews and documentation audits
- Ability to independently prioritize and manage work in a remote environment
- Strong technical skills and comfort navigating multiple systems and portals
- Excellent communication, organization, and follow-through.
- Preferred Experience: Medical review, appeals, audit response, or utilization review experience
- Exposure to payer audits and contractor review processes
- Experience supporting compliance, quality, accreditation, or regulatory initiatives
- Experience with EMR platforms and documentation tracking systems
- Background working with billing, reimbursement, or operational compliance functions
Benefits
Comp & perks- Medical, Dental, and Vision coverage
- Pharmacy benefits
- Virtual care and mental health support
- Flexible Spending Accounts (FSA) and Health Savings Account (HSA)
- Supplemental health and life insurance
- 401(k) with company match
- Employee referral program
- Prepaid legal services
- Identity theft protection
- Generous paid time off
- Pet insurance
- Tuition and continuing education reimbursement
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical chart reviewsdocumentation auditsmedical reviewappealsaudit responseutilization reviewcompliancequalityaccreditationregulatory initiatives
Soft Skills
communicationorganizationfollow-throughprioritizationindependent work
Certifications
Registered Nurse (RN) license