Clinical Compliance Program Manager

Help at Home is the leading national provider of in-home personal care services, where our mission is to enable individuals to live with independence and dignity at home. Our team supports 66,000 clients monthly with the help of 49,000 compassionate caregivers across 12 states. We’re focused on serving people and the communities we are part of.
The Care Coordination and Care Delivery business lines deliver in home services in four states across the country. The Clinical Compliance Program Manager will ensure that the programs are compliant with local, state, and national guidelines with a particular emphasis on Medicare compliance.
 

Job Summary:

The Clinical Compliance Program Manager collaborates with key stakeholders to develop, deliver and oversee our Compliance Program. This role serves as our Clinical Compliance lead and will work closely with executive leadership to cultivate a culture of compliance and carry out all necessary steps to roll-out and maintain an effective Clinical Compliance Program.  This position will identify scope of program and associated metrics, as well as best practices and overall framework of the organization’s Compliance Program.  This will include, advising, developing, implementing, maintaining, and evaluating an effective, data-driven, Compliance Program(s) with participation from other members of the interdisciplinary team. The Compliance Program Manager’s role will also inform the business of potential areas of risk and opportunities for improvement – in both Care Coordination and Care Delivery. Must have effective communications across multiple stakeholders and must manage an effective Compliance Program that mitigates risk and positively influences clinical quality outcomes.
 

• You are flexible and can embrace change.
• You value progress over perfection
• You care about your work, the team you’re on, and the people we are helping
• You make it a priority to get to know the people around you – build relationships with your colleagues and business partners
• You say what needs to be said, while considering how it’ll affect culture and output
• Hold others to a high standard

• Develops and administers the organization’s Compliance Program and related initiatives for both lines of business – Care Delivery and Care Coordination. Mitigates risk through the execution of an effective Compliance initiatives & program 
• Informs strategy and executes activities related to Clinical Compliance for both lines of business – Care Coordination and Care Delivery.  May include compliance activities related to billing, training, aligning EHR, client intake forms, credentialing, and other related activities.
• Informs policy and procedures to drive compliance, including that related to government agencies such as Medicare and Medicaid, & informs senior leaders of potential areas of risk related to compliance
• Establishes best practices to support compliance and works closely with Quality Lead to align Quality Program initiatives to support Compliance requirements/initiatives
• Leads the development of compliance initiatives that result in improvements in processes, practices and initiatives that positively affect clinical quality outcomes.
• Facilitates the development, implementation and integration of compliance activities into standard operating procedures through teamwork and collaboration with internal teams. 
• Provides guidance, interpretation, and subject matter expertise to clinical and operations teams regarding compliance policies and procedures, clinical standards, quality improvement tools and electronic applications.
• Maintains knowledge of Medicare trends and ensures organization stays Medicare compliant
• Collaborates with operations and learning and development on the tactical execution of compliance initiatives, interventions, and standardized education materials.
• Collaborates with appropriate stakeholders including but not limited to the Clinical Quality leadership, Education, Clinical Services, Regulatory and Compliance and Value-based partnerships to take the appropriate steps to facilitate identification and achievement of compliance initiatives and ongoing patient safety improvement.
• Oversees compliance audits and risk assessments, and implementation/communication of findings to senior leadership
• Supervises and maintains all compliance reporting related to reimbursement and quality ratings.
• Identifies risk areas and opportunities for improvement and assists with root cause analysis and action plan development and evaluation as needed.
• Ensures that regulatory guidelines are met regarding Joint Commission standards, Department of Health regulations and CMS Conditions of Participation. Analyze and report the impacts of outcomes on CMS Star Ratings and Pay for Performance Programs.
• Assists in coordinating investigations of reportable incidents/complaints, sentinel events, citations, and data collection for corrective actions.
• Monitors status of compliance with corrective action plans until corrected and closed.

• Ability to maintain knowledge & database of core Clinical Compliance regulations/measures established by CMS.
• Detail oriented; strong problem/situation analysis.
• Strong communication skills, oral and written.
• Excellent interpersonal skills; ability to build collaborative relationships with Matrix partners
• Ability to thrive in an ambiguous environment
• Proficient with Microsoft Office Suite, especially Excel.

Education and Experience:

• Bachelor's Degree in healthcare related field
• Minimum of seven (7) years of experience in a Healthcare Compliance role.
• Experience in Medicare Clinical Compliance a must
• Familiarity with Medicare regulations, experience with audit preparation and demonstrated ability to keep up with changing regulations.
• Experience setting up and/or managing a Primary Care Practice a bonus
• Experience with coding requirements for Medicare
• CPHQ® certification preferred.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.

Help At Home is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, religion, national origin, age, disability, veteran status, genetic data, or religion or other legally protected status.

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