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Community Health Programs, Inc. · 4 hours ago

Compliance, Quality and Risk Manager - Hybrid

Great Barrington, MA

Full-time

Hybrid

Mid, Senior Level

$76K/yr - $88K/yr

Community Health Programs is a nonprofit health care provider that offers primary and preventive care. The Compliance, Quality and Risk Manager is responsible for implementing compliance and quality processes, ensuring adherence to regulatory requirements, and promoting a culture of ethical conduct and patient safety.

DentalHealth CareHospitalMedical

Responsibilities

Implement and monitor the organization’s Compliance Program in alignment with HRSA, CMS, OIG, HIPAA, ACO and UDS requirements under established program guidelines and COO direction

Maintain current knowledge of regulatory requirements and assist with updating policies as directed by leadership

Conduct medical record audits following established processes as prioritized by the annual work plan, quality related initiatives, or payer requests

Manage the anonymous reporting hotline and perform investigations, ensuring timely documentation and follow-up, under the oversight of the COO

Support corrective action plans and escalate findings to leadership for review and approval

Coordinates QA/PI activities including patient experience surveys and reviews, clinical quality measure satisfaction (UDS measures, HEDIS measures, Annual Wellness Visits), pursuant to HRSA and PCMH requirements, value-based care agreements, pay for performance and other population health initiatives

Analyzes and audits quality data to present to leadership to determine action plans to enhance organizational performance in relation to quality measures and value-based/pay-for-performance initiatives

Provides education to departments on quality standards and initiatives

Supports risk management activities by tracking incidents and assisting with mitigation steps under established plans

Monitor incident reports, patient safety events, and trends to reduce organizational risk

Collaborate with clinical leadership to enhance patient safety and quality improvement initiatives

Coordinates documentation and assists with readiness activities for audits and surveys as directed by leadership

Monitor changes in federal and state regulations and communicate impacts to leadership

Qualification

Compliance Program ManagementQuality Assurance CoordinationRisk ManagementFQHC ProgramsData AnalysisCommunication SkillsTeam CollaborationProblem Solving