Summary: The Manager, Healthcare Compliance and Risk Management will be responsible for the development, implementation and monitoring of a healthcare compliance and patient safety risk management program. This role will be responsible for providing compliance and patient safety oversight, guidance and direction to Heartland Alliance Health (HAH) and Heartland Alliance (HA) programs. The position is a part of the Enterprise Risk Management (ERM) department and reports directly to the Chief Growth Officer for HAH.
Essential Duties and Responsibilities:
- Assists development of HAH compliance program.
- Oversees HAH policy management workflows and policy
- Develops and maintains relevant policies, procedures, training and compliance plans related to the compliance program.
- Ensures HAH policies and practices comply with federal and state laws/regulations and follow industry guidelines to prevent illegal, unethical, or improper conduct.
- Develops, presents and manages an annual compliance calendar identifying all requirements to be completed by HAH, including timetables and accountability measures.
- Assists with identification, implementation, and maintenance of entity privacy policies.
- Works with ERM and HAH teams to ensure day-to-day operations of the program are established. Partners with teams and staff to identify areas where compliance input and guidance is required.
- In accordance with the compliance program and plan, monitors business activities and conducts systematic review for compliance with applicable rules and regulations to include HIPAA, Accreditation, CMS, and FTCA and HRSA Compliance Manuals. Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.
- Specifically manages organization re-certifications for FTCA, CARF, PCMH and accreditation Quality Improvement Plan (QIP).
- Communicates updates and changes on regulatory and legal changes including HRSA Compliance manual, PINs, and Pals.
- Oversee operational audits ensuring organization compliance with internal and external policies and requirements
- With ERM department, monitors CMS compliance and sanction adherence.
- Leads HAH CARF accreditation survey, survey preparation and follow-up and ongoing readiness assessments or monitors.
- Leads preparation for HRSA reviews, review preparation, coordination and follow-up.
- Participates in PCMH accreditation preparation and follow-up.
- Oversees False Claim reporting.
Patient Safety Risk Management
- Contributes to the Enterprise Risk Management Plan; Coordinates process for patient safety risk identification and mitigation and executes annual patient safety risk management work plan.
- Coordinates and provides risk management training for HAH staff and other stakeholders.
- Contributes to leadership training and discussions and business processes to imbed identification of company key and event based risk and clinical risks. Elevates such risk to HAH Senior Leadership Team and Chief Risk Officer.
- Oversees Incident Reporting process and staff training for HAH. Ensures incident reports are accurate and responded to in a timely fashion. Facilitates root cause analysis investigations of sentinel events.
- Manages, collects, and evaluates data concerning participant incident reports, aggregates data summaries, and develops quarterly risk management reports that include trend analyses of incidents, claims and grievances.
- Assists leaders in completing quarterly risk assessments and identifies high risk areas.
- Creates annual reports for key staff and board of directors Ensures the HAH Safety and Emergency Preparedness Team, the HAH Health and Safety Committee and the Emergency Preparedness Manager (ERM department) are educated on applicable compliance standards for FQHCs, HUD, State Medicaid, Medicare, and CARF.
Ethics, Conflict of Interest, and Investigations:
- Manages HAH related to compliance investigations and resulting corrective action plans. Responds to alleged violations of rules, regulations, policies, procedures, and the HA Code of Ethics by evaluating, recommending and conducting (upon request of CRO) the investigative procedures. Serves as the HAH representative for the ethics reporting hotline.
- With the ERM team, acts as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated and resolved.
- Ensures False Claims reporting mechanisms are in place
- Oversees participant grievance policies and procedures. Tracks and ensures timely response. Trends and provides regular reports to HAH management and ERM.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience:
- Bachelor’s degree required; Master’s Degree in a field of Health Care a plus.
- Compliance and risk management experience in a healthcare environment required; FQHC experience preferred and 2+ years of accreditation experience preferred.
- Strong working knowledge of HIPAA, HRSA, CMS, False Claims Act, Anti-Kickback, OIG and state regulations. Practical understanding of healthcare compliance requirements with the ability to provide appropriate guidance to team members.
- Intermediate-Advanced Computer skills – Microsoft Office (Word, Excel, SharePoint and Outlook).
- Clear and concise interpersonal and verbal communications skills and the ability to communicate effectively with a variety of personnel at all levels both internally and externally.
- Sound judgment and strong commitment to ethical conduct and integrity.
- Strong problem solving skills with the ability to identify relevant risks and propose solutions that consider relevant business objectives and compliance concerns.
- Ability to work independently in a fast-paced and dynamic environment.
- Strong attention to detail, excellent organizational skills, and the ability to work on multiple projects with tight timelines.
- Certified Healthcare Compliance and Risk Management or working toward certifications in Healthcare Compliance and/or Risk Management highly preferred.
Language Skills: Ability to read, analyze, and interpret complex documents. Ability to respond effectively to sensitive inquiries or complaints. Ability to write reports that present data and other information in a logical and cogent manner. Ability to make clear, concise and persuasive speeches and presentations on controversial or complex topics to top management, public groups, and/or boards of directors.
Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
- Accountability – Be responsive, responsible, resourceful,
- principled, and a problem-solver
- Leaderful – Take initiative, communicate effectively, delegate based on skills and interests, possess strategic thinking and acting; develop staff, foster teamwork
- A Bias Toward Action - Advocate for services and policies that support healthier lives for the populations’; be decisive and take action when a problem arises, communicating with those impacted; be proactive, innovative, and consistently work to improve operations and outcomes, carrying out formal continuous improvement initiatives
- Participant centered – Listen to and collaborate with participants, identify strengths and implement evidence- based practices; integrate and coordinate services across HAH programs
- Valuing our colleagues – Be respectful and responsive; appreciative and supportive; provide input, initiative and recognition of colleagues
- Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
- Critical Thinking – Able to identify, assess, and develop effective solutions to organizational threats, risks, and gap that impact quality and operations.
- Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
- Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
- Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
- Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk and hear.
- The employee is frequently required to use hands to key, handle, or feel and reach with hands and arms.
- The employee is regularly required to sit, stand and walk.
- The employee must occasionally lift and/or move up to 10 pounds.
- Specific vision abilities required by this job include close vision and ability to adjust focus.
Heartland Alliance makes all hiring and employment decisions, and operates all programs, services, and functions without regard to race, receipt of an order of protection, creed, color, age, gender, gender identity, marital or parental status, religion, ancestry, national origin, amnesty, physical or mental disability, protected veterans status, genetic information, sexual orientation, immigrant status, political affiliation or belief, use of FMLA, VESSA, military, and family military rights, ex-offender status (depending on the offense and position to be filled), unfavorable military discharge, membership in an organization whose primary purpose is the protection of civil rights or improvement of living conditions and human relations, height, weight, or HIV infection, in accord with the organization's AIDS Policy Statement of September 1987.