MyCare Health Center
Director of Quality and Compliance
MyCare Health Center, Center Line, Michigan, United States, 48015
The Director of Quality & Compliance minimizes the risk of errors, accidents, and other adverse incidents in the company based on sound clinical practices, claims management recommendations, and state, federal, and local laws. This includes a variety of duties related to managing potential risks and liabilities within the practice by creating and implementing policies that improve both patient care and employee safety. The Director of Quality & Compliance works independently and in collaboration with management and clinical directors on quality improvement projects and initiatives, including the implementation of MyCare's Quality Improvement/Assurance Plan. Primary initiatives include Patient Centered Medical Home (PCMH), Risk Management, safety documentation and plan reviews, ER (Environmental Risk), EOC (environment of care), and IC (Infection Control). This position is the point person with the Michigan Community Health Network (MCHN) quality of care goals. This position supervises Community Health Workers. The Director of Quality & Compliance serves as MyCare's Compliance Officer, including, but not limited to, oversight of compliance with HIPAA, 340B, Federal Tort Claims Act (FTCA), staff credentialing, and OSHA regulations; and as such is directly accountable to the MyCare Board of Directors.
SPECIFIC DUTIES AND JOB FUNCTIONS:
Directs and supervises the activities and functions of the risk management program to reduce the risk of adverse outcomes that could result in medical malpractice or other health or health related litigation; prepares and requests pertinent reports and follow up information on actions implemented to improve risk, ensures health center staff receive risk management training, creates and revises risk management policies, completes quarterly risk management assessments and prepares an annual report for the Quality and Compliance Committee and ultimately the Board of Directors.
Responsible for the management and processing of claims-related activities and serves as the claims point of contact including taking control over potential or filed claims against the organization and/or its providers. These activities include identifying potential claims early, notifying the organization’s liability insurance carrier and/or defense counsel of potential claims and lawsuits, evaluating liability and associated costs, identifying and mitigating potential damages, assisting with the defense of claims by scheduling individuals for deposition, providing documents or answers to written interrogatories, implementing alternate dispute-resolution tactics, and investigating adverse events or incidents.
Recruits and supervises Community Health Workers, directing their work based on data analytics to address gaps to improve the patient’s care.
Coordinates the organization’s submission of the annual Uniform Data Set (UDS) Survey, ensuring accuracy of data collected and submitted to the Health Resources and Services Administration.
Directs and supervises the activities and functions of the Quality Improvement/Assurance Plan; prepares and requests pertinent reports and follow up information on actions implemented to improve quality and/or resolve identified problems.
Directs and monitors activities and functions of MyCare's Compliance Plan; managing the annual Compliance Calendar including coordination of responsibilities with assigned leadership.
Provides quarterly reports and updates to the Quality and Compliance Committee whose minutes go to the Board of Directors pertaining to Quality and Compliance, or more frequently as necessary. Has access to the Board of Directors if needed.
Develops and implements policies and procedures consistent with MyCare's mission that guide and support the provision of performance improvement and quality management services.
Conducts, arranges for and supervises quality management data gathering activities for both Quality Improvement and Compliance monitoring.
Collaborates with the management team to develop objective and meaningful quality goals and outcomes; reviews data assessment methods/tools to ensure that both qualitative and quantitative data is accessible to measure important aspects of care/service.
Assists with the integration of quality improvement activities among different professional disciplines including primary care, dental care, and behavioral health care.
Sets standards, develops plans and manages processes to assess, improve and maintain the quality of MyCare's governance, management, clinical and support activities.
Monitors follow up on all quality management issues related to clinical activities, staff, monitoring committees and administration.
Utilizes data and information for clinical practices as they relate to population health, quality improvement and utilization management; organizes multidisciplinary performance improvement teams to address the improvement of patient focused integration of care functions.
In collaboration with the management team, identifies and assesses new or changing practice and regulatory standards, reassesses quality and performance measures and initiates actions necessary to accomplish proposed goals.
As the OHSA Safety Manager, provides oversight of occurrence reporting including incident reports, occurrence reports and sentinel events; follows up as necessary.
Reports serious incidents and/or breaches in the quality of care to the CEO, CFO, COO, CMO, and CDO as appropriate.
Serves as the agency's Privacy Officer ensuring that consumer rights and privacy are being maintained at all times.
Oversees ongoing activities related to the development, implementation, and maintenance of privacy policies in accordance with applicable federal, state, and local laws.
Provides quality and compliance feedback to various committees including, but not limited to: Executive Leadership Team, Quality and Compliance Committee, and MyCare Board of Directors.
Participates in the development of agency workflows to assure compliance with FQHC, NCQA, FTCA and other regulatory standards; assures staff adherence to policies and procedures.
Participates in meetings/conferences and continuing education and demonstrates a genuine desire to develop strategies for improved clinic operations and high-level patient care.
Promotes the integration of services including primary care, behavioral health, and dental; serves as a resource to other providers and staff.
Updates job knowledge by studying trends in and developments in laws, policies, and regulations affecting the organization.
Completes audits to ensure compliance with quality standards and implements action plans to address any noncompliant area(s).
Determines system/process improvements needed and implements necessary changes in collaboration with executive and clinical leadership.
Ensures OSHA training for staff.
Represents MyCare by participating in selected local, state and national committees and work groups.
Travels when necessary to meet organizational needs.
As directed by a supervisor, performs other related and/or necessary tasks to achieve organizational and programmatic goals and objectives.
Responsible for personal compliance in full with all applicable federal, state, local and health center rules, regulations, protocols and procedures including, but, not limited to, personnel issues, work place safety, public health and confidentiality.
Responsible for compliance with all MyCare policies and procedures.
Promote efficient, organized and pleasant office operations in the health center and in the community consistent with the mission of MyCare to offer care in an atmosphere of dignity and respect.
KNOWLEDGE SKILLS AND ABILITIES:
Must have knowledge of HIPAA privacy/security laws.
Must demonstrate excellent interpersonal and team building skills.
Must have excellent decision making skills and attention to detail and accuracy.
Must have excellent organizational skills.
Must demonstrate effective verbal, written and listening communication skills.
Demonstrated skills in collaboration, teamwork, and problem-solving to achieve goals.
Possess excellent computer skills including spreadsheet, word-processing programs, data analytics, email and Electronic Medical/Dental Record at a highly proficient level.
Must possess or be willing to obtain risk management training.
Knowledge of AllScripts EHR, Dentrix Enterprise EDR, and Azara data reporting and analytics preferred.
Must possess stress management and time management skills, and the ability to multi-task efficiently.
PERSONAL ATTRIBUTES:
Must maintain strict confidentiality in performing the assigned duties.
Must be honest and trustworthy, respectful of others.
Must be flexible and possess cultural awareness and sensitivity.
Must demonstrate ability to work collaboratively with Executive Team members.
Must demonstrate a commitment to the mission of MyCare Health Center.
MINIMUM QUALIFICATIONS:
Bachelor's degree or equivalent experience of 5 years in healthcare setting required; Bachelor of Science in Nursing or other allied health profession preferred.
At least 2 years' experience in a documented healthcare management and/or OHSA officer role.
Prior work experience in Federally Qualified Health Centers (FQHC) preferred.
Must be able to communicate effectively to staff, board members, and outside agencies.
CPR Certification offered; not required.
MyCare Health Center is an Equal Opportunity Employer. Applicants will be considered for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristics protected by applicable law.
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SPECIFIC DUTIES AND JOB FUNCTIONS:
Directs and supervises the activities and functions of the risk management program to reduce the risk of adverse outcomes that could result in medical malpractice or other health or health related litigation; prepares and requests pertinent reports and follow up information on actions implemented to improve risk, ensures health center staff receive risk management training, creates and revises risk management policies, completes quarterly risk management assessments and prepares an annual report for the Quality and Compliance Committee and ultimately the Board of Directors.
Responsible for the management and processing of claims-related activities and serves as the claims point of contact including taking control over potential or filed claims against the organization and/or its providers. These activities include identifying potential claims early, notifying the organization’s liability insurance carrier and/or defense counsel of potential claims and lawsuits, evaluating liability and associated costs, identifying and mitigating potential damages, assisting with the defense of claims by scheduling individuals for deposition, providing documents or answers to written interrogatories, implementing alternate dispute-resolution tactics, and investigating adverse events or incidents.
Recruits and supervises Community Health Workers, directing their work based on data analytics to address gaps to improve the patient’s care.
Coordinates the organization’s submission of the annual Uniform Data Set (UDS) Survey, ensuring accuracy of data collected and submitted to the Health Resources and Services Administration.
Directs and supervises the activities and functions of the Quality Improvement/Assurance Plan; prepares and requests pertinent reports and follow up information on actions implemented to improve quality and/or resolve identified problems.
Directs and monitors activities and functions of MyCare's Compliance Plan; managing the annual Compliance Calendar including coordination of responsibilities with assigned leadership.
Provides quarterly reports and updates to the Quality and Compliance Committee whose minutes go to the Board of Directors pertaining to Quality and Compliance, or more frequently as necessary. Has access to the Board of Directors if needed.
Develops and implements policies and procedures consistent with MyCare's mission that guide and support the provision of performance improvement and quality management services.
Conducts, arranges for and supervises quality management data gathering activities for both Quality Improvement and Compliance monitoring.
Collaborates with the management team to develop objective and meaningful quality goals and outcomes; reviews data assessment methods/tools to ensure that both qualitative and quantitative data is accessible to measure important aspects of care/service.
Assists with the integration of quality improvement activities among different professional disciplines including primary care, dental care, and behavioral health care.
Sets standards, develops plans and manages processes to assess, improve and maintain the quality of MyCare's governance, management, clinical and support activities.
Monitors follow up on all quality management issues related to clinical activities, staff, monitoring committees and administration.
Utilizes data and information for clinical practices as they relate to population health, quality improvement and utilization management; organizes multidisciplinary performance improvement teams to address the improvement of patient focused integration of care functions.
In collaboration with the management team, identifies and assesses new or changing practice and regulatory standards, reassesses quality and performance measures and initiates actions necessary to accomplish proposed goals.
As the OHSA Safety Manager, provides oversight of occurrence reporting including incident reports, occurrence reports and sentinel events; follows up as necessary.
Reports serious incidents and/or breaches in the quality of care to the CEO, CFO, COO, CMO, and CDO as appropriate.
Serves as the agency's Privacy Officer ensuring that consumer rights and privacy are being maintained at all times.
Oversees ongoing activities related to the development, implementation, and maintenance of privacy policies in accordance with applicable federal, state, and local laws.
Provides quality and compliance feedback to various committees including, but not limited to: Executive Leadership Team, Quality and Compliance Committee, and MyCare Board of Directors.
Participates in the development of agency workflows to assure compliance with FQHC, NCQA, FTCA and other regulatory standards; assures staff adherence to policies and procedures.
Participates in meetings/conferences and continuing education and demonstrates a genuine desire to develop strategies for improved clinic operations and high-level patient care.
Promotes the integration of services including primary care, behavioral health, and dental; serves as a resource to other providers and staff.
Updates job knowledge by studying trends in and developments in laws, policies, and regulations affecting the organization.
Completes audits to ensure compliance with quality standards and implements action plans to address any noncompliant area(s).
Determines system/process improvements needed and implements necessary changes in collaboration with executive and clinical leadership.
Ensures OSHA training for staff.
Represents MyCare by participating in selected local, state and national committees and work groups.
Travels when necessary to meet organizational needs.
As directed by a supervisor, performs other related and/or necessary tasks to achieve organizational and programmatic goals and objectives.
Responsible for personal compliance in full with all applicable federal, state, local and health center rules, regulations, protocols and procedures including, but, not limited to, personnel issues, work place safety, public health and confidentiality.
Responsible for compliance with all MyCare policies and procedures.
Promote efficient, organized and pleasant office operations in the health center and in the community consistent with the mission of MyCare to offer care in an atmosphere of dignity and respect.
KNOWLEDGE SKILLS AND ABILITIES:
Must have knowledge of HIPAA privacy/security laws.
Must demonstrate excellent interpersonal and team building skills.
Must have excellent decision making skills and attention to detail and accuracy.
Must have excellent organizational skills.
Must demonstrate effective verbal, written and listening communication skills.
Demonstrated skills in collaboration, teamwork, and problem-solving to achieve goals.
Possess excellent computer skills including spreadsheet, word-processing programs, data analytics, email and Electronic Medical/Dental Record at a highly proficient level.
Must possess or be willing to obtain risk management training.
Knowledge of AllScripts EHR, Dentrix Enterprise EDR, and Azara data reporting and analytics preferred.
Must possess stress management and time management skills, and the ability to multi-task efficiently.
PERSONAL ATTRIBUTES:
Must maintain strict confidentiality in performing the assigned duties.
Must be honest and trustworthy, respectful of others.
Must be flexible and possess cultural awareness and sensitivity.
Must demonstrate ability to work collaboratively with Executive Team members.
Must demonstrate a commitment to the mission of MyCare Health Center.
MINIMUM QUALIFICATIONS:
Bachelor's degree or equivalent experience of 5 years in healthcare setting required; Bachelor of Science in Nursing or other allied health profession preferred.
At least 2 years' experience in a documented healthcare management and/or OHSA officer role.
Prior work experience in Federally Qualified Health Centers (FQHC) preferred.
Must be able to communicate effectively to staff, board members, and outside agencies.
CPR Certification offered; not required.
MyCare Health Center is an Equal Opportunity Employer. Applicants will be considered for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristics protected by applicable law.
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