Director of Risk Management and Compliance
Job Posting for Director of Risk Management and Compliance at CommuniCare+OLE
POSITION TITLE: Director of Risk Management and Compliance
DEPARTMENT: Quality Improvement
REPORTS TO: Chief Administrative and Operations Officer
SUPERVISION GIVEN: yes
About CommuniCare OLE
Established in 2023, CommuniCare OLE is the result of a union of two health centers with deep roots in their respective communities and reputations for providing high-quality primary care to all, regardless of insurance or ability to pay: OLE Health of Napa and Solano Counties and CommuniCare Health Centers of Yolo County. Building on a legacy established by both organizations in 1972, CommuniCare OLE is a network of federally-qualified health centers with 17 sites across Napa, Solano, and Yolo Counties. It offers comprehensive care, including medical, dental, behavioral health and substance use treatment, nutrition, optometry, pharmacy, care coordination, referrals, and enrollment assistance to more than 70,000 individuals, and no one is turned away due to lack of insurance, immigration status, or ability to pay. Many services are offered outside of its sites, including mobile health, home visiting, and community and school-based programs.
The following statements are intended to describe the major elements and requirements of the position and should not be taken as an all-inclusive list of responsibilities, duties, and skills required of individuals assigned to this job.
JOB SUMMARY: The Director of Risk Management and Compliance for CommuniCare OLE (CCOLE) is responsible for developing and sustaining strategies, policies, materials, communication, training, monitoring, discipline, investigations and remedial measures to ensure adherence with CCHC risk management and compliance policies and procedures and to ensure that such policies and protocols are in compliance with federal, state and local laws and regulations, including requirements of external funding, regulatory and accreditation agencies. The Director will oversee the organization’s risk management program, assessing and identifying risks that could impede the reputation, safety, security, or financial success of the organization. The position identifies and analyzes risk management and compliance issues, drafts key documents, and presents clear recommendations to Leadership. The Director serves as a resource for staff and Risk and Compliance issues and ensures the ability of all employees to raise questions of compliance and/or risk. The Director works with other leaders to ensure compliance within all CCOLE departments.
EDUCATION, EXPERIENCE, TRAINING
- Master’s degree in health and human service field or bachelor’s degree and five or more years of experience working in healthcare field with progressively increasing responsibility.
- Supervisory experience in a social service or health related organization preferred. Proven experience developing and designing effective programs and materials.
- Certification in Healthcare Compliance required or ability to obtain certification within one year.
KNOWLEDGE OF WORK
1.
Commitment to the provision of health services for the underserved with demonstrated ability and sensitivity in working with a variety of people from low-income population with diverse educational, lifestyle, ethnic and cultural origins
2.
Skill in exercising a high degree of initiative, judgment, discretion and decision-making to achieve CCOLE’s mission.
3.
Skill in analyzing situations accurately and taking effective action.
4.
Skill in establishing and maintaining effective working relationships with employees, policy-making bodies, third-party payors, patients and the public.
5.
Skill in organizing work, delegating and achieving goals and objectives.
6.
Skill in exercising judgment and discretion in developing, applying, interpreting and coordinating departmental policies and procedures.
7.
Knowledge of current regulatory changes in interpretation of laws
8.
Knowledge of or willingness to learn compliance, reimbursement and other requirements as well as all regulatory agencies pertaining to community health centers.
9.
Demonstrate independence and objectivity in all aspects of the risk and compliance program.
10.
Ability to effectively support, motivate and supervise staff, encourage and nurture development and growth, to build a strong and productive team.
11.
Ability to work effectively under pressure in a positive friendly manner in a team-oriented environment and to be flexible and adaptive to change.
12.
Ability to manage change and direct the problem-solving process.
14.
Ability to organize and integrate organizational priorities and deadlines
15.
Ability to analyze and prepare comprehensive reports.
16.
Ability to communicate and collaborate with staff, government officials and the public.
DUTIES AND RESPONSIBILITIES
1.
Conduct organizational risk assessments and oversee a corporate wide risk management program, develop, and maintain a written corporate risk management plan and annual evaluation of the plan’s effectiveness.
2.
Oversee, update, develop, and implement a comprehensive compliance strategy that includes periodic audits, effective lines of communication, and written practice standards and procedures.
2.
Develop and implement a systemic approach for managing and minimizing clinical and enterprise risk that facilitates early identification of new risks, communication, issues management, and internal and external reporting.
3.
Serve as Corporate Compliance Officer and Risk Manager for CommuniCare OLE.
4.
Act of Privacy Officer of the organization and be responsible for all duties associated with this position, including the investigation of and reporting of HIPAA violations and the composition and delivery of responses to state regulatory agency complaints and inquiries.
5.
Develop and monitor the CCHC Corporate Compliance Plan in accordance with state and federal laws, regulations, and policies.
6.
Develop, monitor, coordinate, and submit CCOLE’s Federal Tort Claims Act application.
7.
Analyze and assess compliance with Federally Qualified Health Center standards and requirements.
8.
Assist staff in developing policies and procedures and monitors program compliance through measuring program outcomes and activities. Assist staff in tracking and reporting program outcomes and ensures that the programs are aligned with the corporate compliance program and grant and/or contract requirements.
10.
Coordinate with Billing, IT, and other applicable departments to facilitate the auditing and monitoring of compliance with laws and regulations.
11.
Oversee the internal audit program. Conduct periodic internal audits.
12.
Develop and maintain policies and procedures related to the corporate risk management and compliance program.
13.
Develop and oversee processes for internal incident reporting. Review incident reports and conduct follow up investigations as warranted.
14.
Chair the CCOLE Risk Management Committee.
15.
Oversee all ongoing activities related to the development, implementation, maintenance of, and adherence to the organization’s policies and procedures covering the privacy of, and access to, patient health information in compliance with federal and state laws and the CCOLE’s information privacy practices.
16.
Oversee a compliance and risk management training and education program.
17.
Update CCOLE policies and procedures based on evaluation, evidence, and consensus with other health center leaders.
18.
Lead organization’s efforts for the HRSA On-Site Visit, including the gathering documents, ensuring reviews and Board approval of policies and procedures, and ensuring contract and subaward compliance with HRSA requirements.
19.
Participate in Leadership Team and assist in guiding the strategic direction of the organization.
20.
Other duties as assigned
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