BASIC PURPOSE:
The Director Home Care Services and Regulatory Compliance is responsible for providing leadership and oversight of clinical operations, regulatory compliance, quality assurance, and workforce compliance for homecare and PACE services. This role ensures the delivery of safe, high-quality patient care while maintaining compliance with all applicable federal, state, local, and PACE program requirements. The Director partners closely with operational leadership, Human Resources, Corporate Compliance, Credentialing, and Onboarding teams to support clinical staff performance, licensure and credentialing compliance, audit readiness, regulatory reporting, quality improvement initiatives, and the continuous enhancement of patient outcomes across assigned markets.
ESSENTIAL FUNCTIONS:
Oversee compliance with all applicable federal, state, and local homecare regulations across assigned markets, ensuring organizational adherence to licensing, credentialing, staffing, documentation, patient care, and PACE program requirements.
Oversee the day-to-day clinical operations of homecare services within the PACE program, ensuring participants receive high-quality care in accordance with established clinical standards, regulatory requirements, organizational policies, and individualized care plans.
Monitor and evaluate the quality and effectiveness of clinical services, ensuring compliance with PACE, accreditation, and healthcare regulatory standards while identifying and addressing gaps in care, service delivery, or compliance.
Monitor and interpret changes to state and federal homecare regulations, PACE program requirements, and industry standards, partnering with operational leadership to implement compliant processes, policies, and procedures.
Partner closely with the Compliance team to support regulatory audits, compliance investigations, corrective action plans, risk mitigation initiatives, and ongoing compliance monitoring activities.
Support organizational readiness for state, federal, accreditation, and PACE program audits by maintaining regulatory compliance, coordinating responses, and implementing corrective actions as necessary.
Serve as the primary clinical compliance resource to leadership, field staff, and internal departments by providing guidance related to regulatory requirements, accreditation standards, clinical practices, and PACE program compliance expectations.
Work collaboratively with Senior Leadership to develop and implement initiatives that improve patient outcomes, strengthen clinical operations, enhance compliance, and increase organizational efficiency through data-driven decision making.
Conduct regular in-home visits and clinical oversight activities to assess quality of care, participant outcomes, caregiver performance, and adherence to established care plans and regulatory standards.
Analyze data, audit findings, quality indicators, and home visit outcomes to identify trends, mitigate risks, recommend improvements, and support continuous quality improvement initiatives.
Oversee the completion and maintenance of accurate clinical documentation to ensure compliance with PACE requirements, payer standards, state regulations, and company policies.
Conduct routine audits of clinical, onboarding, credentialing, licensure, and compliance records to identify gaps, ensure regulatory readiness, and support ongoing quality assurance efforts.
Oversee clinical license compliance activities, including verification, tracking, renewals, monitoring, and maintenance of professional licenses, certifications, background screenings, and other required credentials.
Collaborate with Onboarding, Credentialing, Human Resources, Compliance, Operations, and Clinical Leadership teams to ensure timely onboarding, licensure verification, workforce compliance, competency validation, and ongoing credential maintenance for clinical personnel.
Establish and maintain processes to ensure all clinical personnel satisfy regulatory,…