Regulatory Review Specialist (RN)
External
Vitalcaringgroup · Dallas, TXPrepare for this interview
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About the role
Founded in 2021, VitalCaring has quickly become a leading provider of home health and hospice services across the country. Our mission is simple: deliver exceptional patient care while creating a workplace where team members feel supported, empowered, and inspired. At VitalCaring, quality and compliance are more than requirements-they're essential to ensuring patients receive the right care at the right time. We are seeking a highly detail-oriented Regulatory Review Specialist (RN) to join our Clinical Regulatory Compliance team and help drive excellence across our organization. Why Join VitalCaring? Make a Meaningful Impact Your expertise will directly support regulatory readiness, compliance excellence, and quality outcomes that protect patient care. Be Part of Something Bigger Partner cross-functionally with clinical, operational, billing, and compliance teams to strengthen processes and maintain regulatory integrity. Work with Purpose and Flexibility Enjoy the ability to work independently in a remote environment while contributing to high-impact initiatives across the organization. Grow Your Expertise Expand your knowledge of healthcare regulations, medical review processes, payer requirements, and compliance strategy. Position Overview The Regulatory Review Specialist (RN) serves as a key member of the Clinical Regulatory Compliance team, supporting medical reviews, audit response activities, and regulatory documentation processes across home health and hospice operations. In this role, you will coordinate and compile documentation for payer audits, CMS and contractor medical reviews, appeals, internal monitoring activities, and compliance initiatives. Success in this role requires strong clinical judgment, exceptional organization, regulatory knowledge, and the ability to thrive in a remote environment.
Responsibilities
- 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
- Required Qualifications
- 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
Additional Information
Join VitalCaring - Where Your Expertise Protects Patient Care Regulatory Review Specialist (RN) - Home Office (Remote)
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