Director of Quality, Risk Management & Compliance

CBIZ is assisting our client in their search for a Director of Quality, Risk Management, and Compliance in Great Neck, NY.

The Director of Quality, Risk Management, and Compliance is responsible for overseeing and directing all activities related to quality improvement, risk management, and regulatory compliance. This role ensures that the organization maintains high standards of care and operates in compliance with federal, state, and local regulations. The Director will develop and implement strategies to enhance patient care quality, minimize risks, and ensure adherence to applicable laws and guidelines.

The Director Quality, Risk Management and Compliance reports to the Chief Executive Officer.

Responsibilities

Risk Management

• Identify potential risks and implement strategies to mitigate them, including the development of risk management policies and procedures
• Conduct risk assessments and develop action plans to address identified risks.
• Lead all provider investigations in collaboration with physician leadership and legal counsel as may be required
• Oversee incident reporting and investigation processes to identify trends and prevent recurrence
• Provide training and support to staff on risk management practices and protocols

Compliance Management

• Serve as Compliance Officer contact to CMS for the Medicare Shared Savings Program and Medicare Qualified Registry (for reporting MIPS and other APM data)
• Ensure the organization complies with all federal, state, and local regulations
• Develop and update compliance policies and procedures to reflect changes in regulations and best practices.
• Conduct regular compliance audits and reviews to identify and address potential issues
• Serve as the primary point of contact for regulatory agencies and manage compliance-related correspondence and documentation

Quality Improvement

• Develop, implement, and manage the organization's Quality Improvement (QI) program to enhance patient care and operational efficiency
• Monitor and evaluate clinical performance indicators and patient outcomes
• Facilitate and lead QI initiatives, including setting goals, developing action plans, and tracking progress
• Conduct regular audits and assessments to ensure compliance with internal policies and external regulations
• Ensures continuous improvement by evaluating and making recommendations considering market demands, regulatory standards and clinical practice
• Work closely with Physician Leadership and key stakeholders to ensure all clinical and quality metrics are accomplished
• In coordination with Physician Leadership, develop, implement and support enforcement of clinical policies
• Monitor clinical compliance of medical providers MD/DO, NP, PA and share with respective leaders (Examples include note closure, clinical documentation, coding & billing, quality performance measures)
• Work closely on CAHPS program and process to improve outcomes year over year

Leadership

• Educate and Evangelize the quality, risk management and compliance initiatives and policies across the organization to build a culture of continuous improvement and accountability
• Collaborate with other departments to integrate quality, risk management, and compliance efforts into overall organizational operations
• Coordinate quarterly Compliance Committee and Quality Management Committee and any related sub-committees

Qualifications

• Master's degree or higher in a related field highly preferred; Bachelor’s Degree required
• 10+ years of experience in a leadership position in a physician-driven organization with high Medicare and Medicare Advantage focus
• Strong interpersonal skills which allow effective interaction with physician leaders, clinical providers, management and staff
• Proficiency in Microsoft Office Suite, including Excel, PowerPoint, Word, Outlook and SharePoint
• Strong Electronic Health Records (EHR) experience; Athena is a plus
• Strong Proficiency with regulations governing healthcare provider organizations required ; expertise as it relates to CMS and Federal guidelines for medical groups, Medicare Shared Savings Program ACOs, and Medicare Qualified Registries (MIPS) is highly preferred. Knowledge of NYS laws and regulations also required
• Knowledge and interest in medical coding and documentation to effectively oversee compliance programs and collaborate proactively with physician leadership
• Proficiency with continuous quality improvement and ability to evangelize and make it part of our organization’s DNA
• Experience developing and overseeing all quality assurance and risk management programs, ranging from annual QI plans, payor audits, clinical documentation, targeted reviews (specific CPTs, modifiers, ICD10s or providers) and action plans based on findings and ability to “sell” and communicate this to the physicians and executive leadership
• Experience and comfort with early-stage healthcare organizations (development and refinement of policies; change management; working up and down the organizational structure to ensure performance and compliance)

Estimating salary range is between $135-$150K

CBIZ is an Equal Opportunity Employer.
CBIZ does not discriminate on the basis of race, ancestry, national origin, color, religion, sex, gender identity, age, marital status, sexual orientation, disability, veteran status, or any other protected classification under the law.