Compliance Nurse (#MDGZ02)

Summary Statement

A class incumbent is responsible for surveying health care agencies and facilities to ensure that all regulatory requirements are met for certification and/or licensure.

Nature and Scope

An incumbent in this class works under the general supervision of a technical superior ensuring regulatory compliance by health care facilities with requirements for licensure and/or certification. Incumbents determine appropriate levels of care for medicaid eligible clients in a health care facility including confirmation of present level of care and/or adverse changes in the level care. Work includes the complete medical review of patients, patients records and the health care facility. A significant aspect of the work involves investigation of complaints against facilities or allegations of specific violations of state/federal health care regulations.

Essential Functions

Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.

  • Conducts survey of facilities and agencies for certification and/or licensure by the State and
  • Consults with agencies and facilities to assist them in meeting requirements and improving
    overall health care delivery.  
  • Conduct investigations of complaints against agencies/facilities to include allegations of
    violations against health care regulations and patient care.  
  • Conducts in-service training programs at health care facilities or in the community in order to
    educate provides and other interested groups in state-of-the-art health care.  
  • Prepares and maintains a variety of records, reports, and summaries and may be required to
    appear in courts of law or before boards and commissions.

Knowledge, Skills and Abilities

The intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.

  • Knowledge of survey and compliance evaluation techniques to include both federal and state
    regulatory requirements.
  • Knowledge of a variety of resources available to health care facilities and providers to ensure that they meet established guidelines for licensure and/or certification.
  • Skill in writing clear, complete, and concise reports, records, and summaries.
  • Skill in communicating effectively with a variety of personnel from private and public sector
    health care facilities.
  • Ability to analyze problem areas, select appropriate corrective courses of action, and recommend same to ensure regulatory compliance.
  • Ability to interpret a variety of regulations, synthesize the same, and ensure that requirements
    are followed by all health care providers.

Job Requirements

JOB REQUIREMENTS for Compliance Nurse
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

  1. At least two years’ experience as a Registered Nurse OR a Bachelors’ degree or higher in Nursing and at least one year of experience as a Registered Nurse OR a Masters’ degree or higher in Nursing.
  2. Possession of a Delaware Registered Nurse license OR multi-state compact license.