Risk & Compliance Manager
The Risk & Compliance Manager will be responsible for supporting the organization's Comprehensive Compliance Program, including the development and implementation of the Compliance and Regulatory Plans and supporting organizational response to contracted plan audits. This is a hands-on role requiring both strategic thought and direct attention to detail. Specific responsibilities include policy and process implementation, leading effective training programs, conducting internal monitoring, directing investigations and corrective actions as needed, and facilitating various risk management committees to help ensure organizational compliance with applicable laws, regulations, industry guidance and internal Policies. Reporting to the Director of Human Resources & Compliance, this individual will work closely and cross-functionally with management peers and functional units throughout our organization to lead and support compliance initiatives, and to raise the level of awareness of compliance within our organization. This is a key and highly visible position with the responsibility of developing and maintaining a strong organization compliance program with the talent, infrastructure, and culture.
RESPONSIBILITIES
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned.
Risk Management
Kheir Clinic will consider for employment all qualified Applicants, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.
Please note that this job description is subject to change to meet the needs of Kheir Clinic.
The Risk & Compliance Manager will be responsible for supporting the organization's Comprehensive Compliance Program, including the development and implementation of the Compliance and Regulatory Plans and supporting organizational response to contracted plan audits. This is a hands-on role requiring both strategic thought and direct attention to detail. Specific responsibilities include policy and process implementation, leading effective training programs, conducting internal monitoring, directing investigations and corrective actions as needed, and facilitating various risk management committees to help ensure organizational compliance with applicable laws, regulations, industry guidance and internal Policies. Reporting to the Director of Human Resources & Compliance, this individual will work closely and cross-functionally with management peers and functional units throughout our organization to lead and support compliance initiatives, and to raise the level of awareness of compliance within our organization. This is a key and highly visible position with the responsibility of developing and maintaining a strong organization compliance program with the talent, infrastructure, and culture.
RESPONSIBILITIES
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned.
Risk Management
- Proactively evaluate areas of organizational risk based on internal assessment and external benchmarking and implement strategies and policies that promote patient and staff safety.
- Responsible for coordinating Quarterly Risk Assessments & report findings.
- Ensure proper reporting of Clinic Incidents/Adverse Events
- Take action to address near misses and ensure proper steps for improvement.
- Promote the occurrence reporting process including trending and reporting of results, identification of problem-prone areas, and facilitation of prevention initiatives.
- Lead the review of serious occurrences requiring root-cause analysis or failure mode and effects analysis. Disseminate lessons learned and process improvement plans.
- Analyze all statistical reports and advisories that identify risk management and patient safety patterns and trends for leadership.
- Lead the organization's Emergency Management program.
- Ensure all facility licenses are up to date for all Kheir locations.
- Responsible for the organization's risk management training plan.
- Ensure that all staff receive required training on essential topics and areas necessary for the health center and for successful audit compliance.
- When appropriate, will facilitate and lead required trainings for staff.
- Prepare & revise the Compliance Plan as dictated by changes in statutes, rules, regulations and requirements of Federal, state and health plans. Take responsibility for all reporting requirements contained within the plan.
- Prepare annual work plans addressing the priority compliance risk exposures for review by the Compliance Committee.
- Ensure compliance with federal, state, and local regulations, particularly FTCA and HRSA requirements.
- Develop, coordinate, and participate in educational and training programs that focus on the elements of the Compliance Program.
- Prepare and submit necessary compliance reports to regulatory agencies as required.
- Ensure that all appropriate employees and managers are knowledgeable of, and comply with, pertinent Federal, State and payer health care program requirements.
- Develop and implement methods and programs that encourage managers and employees to report possible noncompliance.
- Coordinate with other department heads to ensure seamless implementation of policies and procedures between Compliance and Operations.
- Identify high risk areas to reduce agency's vulnerability to fraud, waste and abuse.
- Exercise day to day responsibility in the oversight of HIPAA training and compliance; act as HIPAA Privacy Officer.
- Ensure Clinic policies align with regulatory requirements.
- Foster open communication with all departments to promote compliance as a shared responsibility.
- Oversee the internal and external credentialing & privileging process for healthcare providers, ensuring all documentation is complete and compliant with internal policies and external regulations.
- Ensure thorough background checks, reference checks, and verification of licenses, certifications, and education for all healthcare providers.
- Certify timely submission of credentialing applications to insurance companies and other governing bodies.
- Work closely with the Human Resources department to coordinate onboarding processes for new providers.
- Ensure maintenance of provider credentialing databases and systems to ensure accurate and up-to-date information.
- Plan and conduct internal audits to assess compliance with established policies, procedures, and regulatory requirements.
- Develop audit schedules and report findings to senior leadership, providing recommendations for corrective actions as needed.
- Follow up on audit findings to ensure that corrective actions are implemented effectively and in a timely manner.
- Organize and lead efforts regarding all compliance audits.
- Provide quarterly updates to the leadership team regarding progress toward the Compliance plan and results of related audits and monitoring functions.
- Lead and mentor a team of compliance professionals, fostering a culture of accountability and continuous improvement.
- Set clear performance expectations and conduct regular performance evaluations to ensure team productivity and engagement.
- Organize team meetings to discuss compliance issues, share best practices, and promote collaboration.
- Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems.
- Knowledge of auditing and monitoring procedures.
- Working knowledge of California patient and individual privacy laws and regulations.
- Clear, concise and persuasive writing and presentation skills using information systems, databases, Excel, PowerPoint and Microsoft Word.
- Enjoy working as a member of a cohesive team and is effective at doing so.
- Ability to make meaningful observations and write comprehensive and accurate reports.
- Self-starter who is comfortable making key decisions and holding others accountable for compliance standards.
- Ability to translate/provide cogent advice to senior management regarding the impact of emerging industry trends in compliance enforcement, legislation and regulations on affiliate business strategies.
- Must understand and lead by communicating vision, exhibiting decisiveness, sponsoring change and supporting the larger organization success.
- Must exhibit a credible leadership presence, with the ability to respond to questions with logic, clarity, calmness and authority, leading to desired support of/actions by others.
- Proven leadership skills in a healthcare compliance environment.
- Ability to work well with others to ensure the highest ethical standards.
- Minimum Bachelor's Degree Required or ten (10) years' experience which must include a minimum of eight (8) years' experience in healthcare compliance with demonstrated leadership, and a minimum of five (5) years' experience of supervisory capacity with participation in cross-departmental committees. Exposure to managed care with FQHC knowledge highly desirable.
- Familiarity with operational, financial, quality improvement, and human resources procedures and regulations is required.
- Valid driver's license & auto insurance.
- Excellent interpersonal skills; ability to develop important relationships with key stakeholders.
- Good conflict management and negotiation skills.
- Ability to analyze complex issues to develop relevant and realistic plans, programs and recommendations.
Kheir Clinic will consider for employment all qualified Applicants, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.
Please note that this job description is subject to change to meet the needs of Kheir Clinic.