Summary:
The Quality/Risk/Compliance position is a managerial position requiring daily organizational, communication, and problem-solving skills. Under the general supervision of the Chief Strategy & Growth Officer (CSGO), this individual leads the evaluation and tracking of quality and compliance initiatives and activities for CenterPlace Health. Works with the CSGO to plan, organize, direct, and lead the patient safety and quality improvement processes. Has general oversight for the organization’s electronic health record including content development, reporting and training functions. Assists in designing, running, and managing data review processes for assuring accuracy and integrity of health services data reports. Works closely with contracted payer groups to improve quality outcomes. Reports outcomes and quality monitoring results to management. Manages a process-oriented, company-wide Compliance Program that is guided by standards, policies and procedures, Code of Conduct and HIPAA to ensure conformity with applicable laws and regulations.
DUTIES & RESPONSIBILITIES:
QUALITY
- Provides oversight for the organization’s electronic health record including content development, reporting and training functions.
- Facilitates development and coordination of all health services data reports.
- Develops and maintains current understanding of HEDIS measures and quality incentive programs and requirements.
- Works closely with contracted payer groups to improve quality outcomes.
- Manages databases, policies and procedures related to assigned areas.
- Assists in assuring accuracy and integrity of health services data reports to meet regulatory and operational requirements.
- Supports the development of quality improvement processes, tools and activities.
- Performs data audit functions.
- Participates in activities related to relevant committees and meetings for assigned area.
- Prepares reports and communicates outcomes and quality monitoring results to management.
- Keeps up to date on the latest issues and trends in care management and healthcare through networking, professional memberships, and select journal reading. Synthesizes trends for application and integration into department.
- Participates in special projects and performs other duties as required.
RISK/SAFETY
- Manages the elements of a risk management program address safety of patients and other important issues, which include:
- Consistent application of the risk management program throughout the organization, including all departments and all service locations
- Methods by which a patient may be dismissed from care or refused care.
- Review and analysis of all adverse incidents unexpected for the clinical setting, which may include, but are not limited to; actual and potential infection control, occurrences and breaches, surgical site infections and other healthcare associated infections, involving, or reported by employees, patients, healthcare professions and others.
- Periodic review of all litigation involving the organization and its staff and healthcare professionals.
- Review of all deaths, trauma, or other adverse incidents, including reactions to drugs and materials.
- Review of patient complaints.
- Communications with the professional liability carrier Federal Tort Claims Act (FTCA), and completion of the annual FTCA Deeming Application.
- Establishment and documentation of coverage after normal working hours.
- Methods for prevention of unauthorized prescribing.
- Active surveillance of processes and techniques for detection and prevention of disease, infection, and potential communicable infective sources.
- Development and recommendation of infection control policies and procedures to meet all applicable state and federal requirements.
- Oversight of the Emergency Management Committee
COMPLIANCE:
- Works in conjunction with the internal business leaders and/or their designee as well as Human Resources, Finance, Clinical, Operations and Administration in establishing and maintaining all aspects of the corporate compliance program.
- Ensures that the compliance program effectively prevents and/or detects violations of law, regulations, organization policies and code of conduct. Develops and implements audit and review procedures to ensure ongoing compliance.
- Regularly reviews the organization’s compliance program/status and implements appropriate revisions and
- corrective actions, as indicated, to maintain compliance.
- Coordinates resources to ensure the ongoing effectiveness of the Compliance Program.
- Ensure and monitor retaliation-free reporting channels, including an anonymous reporting system, are available to all employees, volunteers, and associates.
- Implements and maintains systems that ensure appropriate responses to compliance complaints, disclosures, and reported problems, in a timely manner.
- Conducts or oversees internal investigations and actions on matters related to healthcare compliance.
- After review with, and at the direction of the CEO, consults with legal counsel to conduct specialized investigations to confirm or contest reported potential problems.
- Coordinates and oversees audits as mandated by government sources established to investigate and monitor compliance with standards.
- Promptly responds to and cooperatively assists with external investigations following consultation with CEO. Coordinates such activity with relevant management and personnel when appropriate.
- Assist and/or coordinates company-wide prevention and remedial plans which facilitate compliance with quality standards following audits or investigations and ensures a reduction in identified problem areas and improved quality.
Minimum Qualifications: (Experience/Skills/Abilities/Education/Certifications)
- Education: Minimum requirement of bachelor’s degree. Master’s degree in health care or related field preferred. Emphasis quality improvement, project management, outcomes measurement, and data analysis.
- Experience: A minimum of 2 years’ experience in a health care setting working in quality improvement, quality assurance, or risk management. Experience in the development and management of in-service training and education a plus.
- Effective oral and written communication and interpersonal skills required. Prior experience with data, data interpretation and presentation required. Proficient with personal computers, including Windows, Excel, Word, PowerPoint, required.
- Minimum of two years of data analysis activities, preferably in a health care organization, required.
- Special Qualifications: Must have a basic competency with office automation (Word, Excel, Access, and Visio) and working knowledge of analytic techniques, research design and statistical analysis. Understanding of applicable national standards for health care.
Physical Demands:
Walking, standing and/or sitting for prolonged periods of time.
Work Environment:
General office
Supervisory Responsibilities:
May directly supervise others. May be required to provide minor conflict resolution and may be required to aid and resolution beyond minor conflicts.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- AD&D insurance
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Experience:
- Compliance management: 2 years (Preferred)
Work Location: In person