Job Summary
The Director of Risk, Compliance and Privacy is responsible for the facility’s risk management activities, which includes but may not be limited to a general knowledge of the insurance programs, assisting with claims/losses at the facility, interfacing with legal counsel, administering the risk management program on a daily basis, managing and analyzing risk management data, conducting risk management education programs, leading projects focused on loss reduction and patient safety, and complying with risk management standards of The Joint Commission, and other accreditation agencies. Should also be able to work on development, implementation and daily operation of the CareWell Health Compliance Program as well as all related laws and regulations pertaining to CareWell Health l. The position also has responsibility for overseeing CareWell Health Medical Center compliance program, ensuring compliance with all privacy and confidentiality laws including the Health Insurance Portability & Accountability Act (“HIPAA”) and privacy rules and regulations.
Essential Functions:
- Continuously carries out the CareWell Health Medical Center mission to attain excellence in the provision of healthcare services by consistently fulfilling the commitment to quality, and by compassionately and skillfully delivering continuously improving total patient centered service.
- Participates in formulating policy and/or organizational changes.
- Must be highly skilled at working with various departments, and will manage initiatives from inception through implementation
Risk Responsibilities:
- Acts as a risk management subject matter expert and consults with internal and external stakeholders on a wide array of initiatives.
- Focuses on risk reduction, patient safety, patient experience and loss prevention, and collaborates with colleagues across the organization with the goal of maintaining a high-quality, safe environment for patients and associates alike.
- Will collaborate with clinicians and administrators alike, so the ability to understand the complex relationship between root cause, clinical outcomes, risk management, and hospital performance is required.
- Responsibility for risk scenario that arise requiring immediate response and action
- Collaborate with clinical leadership on peer review and Quality & Outcomes Management
- Collaboration with Quality and key Stakeholders to DOH calls of complaint. Ensure compliance with DOH/CMS regulations regarding clinical patient complaints/grievances
Compliance Responsibilities:
- Coordinate development and implementation of the CareWell Health Medical Center compliance program.
- Coordinate design, implementation and/or modification of written policies and procedures related to the Compliance Program.
- Collaborative partner with the organization's response to significant occurrences; review facts; review medical record/documentation; preserve any evidence; interview staff; ensure appropriate corrective action plan and monitoring
- Oversee day to day operations of the compliance department and activities including the coordination of monthly and quarterly compliance committee meetings
- Ensure that compliance reports are prepared accurately and timely for review by management and/or board members. Coordinate with Administration, Finance, Legal, Business Development, Research, IT, Human Resources and other departments in ensuring day to day compliance with the CareWell Health Medical Center compliance policies and procedures and applicable laws and regulations.
- Develop, coordinate and conduct educational sessions and training on various compliance, privacy and ethics topics to all levels of the organization including but not limited to new employee training, recurring training for current employees and specialized training as needed.
- Keep abreast of changes in laws and regulations impacting CareWell Health Medical Center operations. Keep management informed about trends, issues and best practices relating to compliance, privacy and ethics.
- Oversee and maintain an anonymous (i.e. hotline) reporting mechanism and other open lines of communication for employees and other stake holders to inquire or report suspected violations of the Compliance Program, policies and procedures, or other laws and regulations.
- Coordinate with Human Resources, Administration, Legal and other areas of the organization to organize and operate a system of discipline for violations of policies or procedures or applicable laws or regulations.
- Design and implement audits and other monitoring to identify instances of violation of the policies or procedures and other laws and regulations. Coordinate with other areas of the organization to identify and address risk areas and activities.
- Investigate, correct and remediate violations of policies and procedures, and related laws and regulations including coordination with other areas of the organization in reporting and repayment to intermediaries or governmental entities as necessary.
- Oversee CareWell Health Medical Center compliance with HIPAA and confidentiality laws, including (1) design, implementation and/or modification of HIPAA Privacy, Security and Breach Notification policies, (2) investigation, documentation and notification of HIPAA breaches as required by the HIPAA Breach Notification Rule, (3) coordination with IT and other departments on HIPAA Security issues, including required administrative, technical and procedural safeguards, (4) coordination with IT and other departments on Meaningful Use issues.
- Ensure that employees, contractors and medical staff are screened prior to start date and periodically thereafter to identify any individuals or entities convicted of a federal health care offense or excluded from participation in federal or other health care programs and to remove any such individuals as necessary.
- Coordinate with the CareWell Health Medical Center on auditing, monitoring, referral source, contracts and managed care issues.
- Coordinate and operate a system for reporting of conflicts of interest as well as investigation and resolution of such conflicts.
Privacy Responsibilities:
- Ensure compliance with all privacy-related laws and regulations.
- Address privacy-related inquiries, complaints, and requests for access to personal information.
- Serve as the primary point of contact for all privacy-related issues within the organization and are expected to provide accurate and timely responses.
- Conduct privacy assessments and investigations of the organization's data processing activities to identify any risks or gaps in compliance with privacy laws and regulations.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Minimum Education/Certifications
Bachelor’s degree in Nursing or related field, Clinical background required. Master’s Degree preferred.
CPHRM certification preferred or equivalent of 5 plus more years of experience
CPC, CHC, CPA, CIA or similar professional credentials desirable
Minimum Work Experience
At least 3 years of experience in risk management required
Experience in quality management and risk/claims management or other related field in health care, preferred.
Risk management, professional liability or loss control experience required.
Position Type/Expected Hours of Work: Must be willing to work holidays, weekends and provide additional coverage as needed. Strong computer skills including working knowledge of Microsoft Office Suite: Word, Excel and Power Point. Ability to build strong, effective relationships internally throughout the organizations locations and externally as needed to support the company’s business activities. Strong initiative, leadership, analytical, verbal and written communication skills. Highest integrity and excellent judgment. Strong planning, organizational, and change management skills.
