Compliance & Risk Manager

POSITION SUMMARY:

The Compliance and Risk Manager plays a crucial role in fulfilling the commitment of Community Medical Centers, Inc. (CMC) to provide the best quality of care possible as well as the continuous assessment and improvement of the quality of care and the services. This position has the principal authority and responsibility for the development, implementation, oversight and evaluation of a dynamic integrated risk management program and compliance program across all CMC clinical and business units. This position reports to the General Counsel.

SPECIFIC DUTIES:

• Oversee, develop, and implement a comprehensive compliance strategy that includes periodic audits, effective lines of communication, written practice standards and procedures and an updated Compliance Plan that reduces CMCs vulnerability to fraud and abuse and ensures compliance with federal and state regulations.
• 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.
• Develop guides and resources on compliance and risk management topics and provide training, knowledge, and skills to staff.
• Oversee, develop, and implement compliance and risk management policies and procedures.
• Responsible for insurance management, requests for certificates of insurance and review of insurance and liability clauses in contracts.
• Act as 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.
• Lead organizations efforts for the HRSA On Site Visit, including gathering documents, ensuring reviews and Board approval of policies and procedures, and ensuring contract and subaward compliance with HRSA requirements.
• In collaboration with the Security Officer, review HIPAA regulations for technology management and participate in conducting required controls including the periodic Risk Assessments.
• In collaboration with clinical leaders, oversee the clinical risk management processes to ensure a culture of safety, timely capture of events, reporting to insurance and federal agencies and initiation of risk analysis for all events.
• Ensure that the HHS OIG's List of Excluded Individuals and Entities, and the General Services Administration's (GSA's) List of Parties Debarred from Federal Programs have been checked with respect to all employees, medical staff and independent contractors.
• Monitor the Compliance Hotline and independently investigate allegations of noncompliance and monitor appropriate corrective action and/or subsequent compliance.
• Serve as the Chair of the Corporate Compliance and the Risk Management Committee.
• Conduct an annual enterprise risk assessment for the organization and report findings to the Board of Directors and key management staff.
• Report on a regular basis to the Board of Directors on the risk and compliance framework implemented at the health center to instill both confidence and understanding of policies and procedures.
• Implement and monitor corrective action plan and/or subsequent compliance developed after compliance investigations.
• Other duties as assigned.

MINIMUM REQUIREMENTS:

• Bachelors degree in related field and a minimum of 5 years of recent experience in health care compliance and risk management at a manager level.
• Knowledge of state and federal healthcare regulations including Human Resources and Services Administration (HRSA) guidelines and CMS Conditions of Participation.
• Excellent written and verbal communication skills
• Valid California Driver's License, proof of insurance and personal transportation.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Highly effective collaboration skills, written and verbal communications skills.
• Computer competent and able to present key information in a succinct and clear manner.
• Ability to facilitate conflict resolution, competent in identification of risk situations and resolution.
• Ability to communicate well with families, patients, staff and physicians based on age, cultural beliefs and educational level.
• Attention to detail, meticulous development and maintenance of regulatory paperwork.
• Speaks with confidence and command.
• Knowledge of organizational policies, procedures and systems
• Ability to interact with internal personnel and external agencies requiring reasonable tact, discretion, and self-expression.
• Ability to maintain open dialogue with supervisors and management staff
• Ability to work independently, use good judgment, maintain excellent communication skills and self-initiative
• Ability to read, understand, and follow oral and written instructions
• Ability to establish and maintain effective working relationships with employees and the public

TYPICAL PHYSICAL DEMANDS:

• Must be able to lift up to 40 pounds and push up to 100 pounds (on wheels)
• Must be able to hear on the phone and those who are served in person, and speak clearly in order to communicate information to staff
• Must have vision with or without lenses that is adequate to read memos, a computer screen, personnel forms and other documents
• Must have high manual dexterity
• Must be able to reach above the shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn, fingering and feeling

TYPICAL WORKING CONDITIONS

Work is performed in an office environment within a clinic setting. Involves frequent contact with staff and the public. Work may be stressful at times. Contact may involve dealing with upset people.

Community Medical Centers is an Equal Opportunity Employer. It is CMCs policy to provide equal employment opportunities to all persons, regardless of age, race, religion, color, national origin, sex, political affiliations, marital status, non-disqualifying physical or mental disability, sexual orientation, membership, or non-membership in an employee organization or on the basis of personal favoritism or other non-merit factors except where otherwise provided by law.