Director of Risk Management and Quality Assurance

Director Of Risk Management & Quality Assurance

The Director of Risk Management & Quality Assurance oversees the daily clinical operations and coordinates all services at the federally qualified health center to ensure continuous quality improvement while remaining compliant with all state and federal regulations. Responsible for the development of the RM/QA policy/plan.

Responsibilities

• Responsible for daily health care center clinical operations including staffing and patient care and ensures compliance with all applicable government regulations.

• Chairs the staff Risk Management/Quality Assurance (RM/QA) committee.

• Conducts quality improvement audits and utilizes the report writer function of the EMR (COGNOS) to generate quality data management activities to minimize risk.

• Reports Risk Management and Quality Assurance activities to the Clinical Quality Sub-Committee (Board and Key Management staff).

• Assumes lead role in performance improvement projects.

• Formulates QA activities to achieve better care, better outcomes, and lower costs.

• Conducts health care center assessments to identify areas of strength and areas in need of development around data quality, clinical performance measures, workflows, and outcomes.

• Participate in recruitment of health care center staff.

• Ensures that patient rights are adhered to as well as addresses patient complaints and/or recommendations in a timely manner.

• Receives and maintains files of all incidents and accidents.

• Reports all incidents within the required timeframes to the New York State Department of Health Office of Health Systems management and reviews all cases of suspected identification of abuse or maltreatment of individuals and ensures appropriate mandated reporting to regulatory agencies.

• Coordinate with the Compliance Administrator to ensure that personnel records are maintained accurately and that all required licenses and certifications of staff are maintained in a confidential and secure manner.

• Ensures overall security and maintenance of the health care facility, including the provision of adequate supplies, equipment, and space.

• Promotes a culture of safety and quality by ensuring continuity and consistency in the implementation of standards, protocols, policies, and procedures.

• Implements CMS Emergency Preparedness rule/regulations.

• Acts as primary liaison to regulatory agencies, community agencies, patients, advocates, and guardians.

• Facilitates preparation for regulatory agency inspections to include DOH, HRSA, CMS and apprises the CEO of progress regarding corrective actions, as necessary.

• Engage in data driven changes to promote practice transformation through implementation of best practices and practice guidelines, team-based care, care management, and care coordination.

• Supports health center in maintaining compliance with the 19 Bureau of Primary Health Care (BPHC) program requirements and other applicable regulations.

• Supports Chief Medical Officer.

• Prepares survey plans of corrective action.

• Oversees PEER Review.

• Facilitates preparation of reports required by the CEO for reporting to the Board of Directors.

• Oversees equipment purchase and repairs, including preventative maintenance.

• Support Chief Medical Officer with Patient Centered Medical Home and reporting quality measure.

• Directly oversees Code Rule 59 and 60 applications and annual reporting in partnership with the Human Resources Director of Employee Services.

• Serves as liaison for IPA and ACO value-based contracts, overseeing quality measurement activities and reporting.

• Overseas the annual submission of the FTCA application.

• Oversees staff training programs to ensure adherence to NYSDOH and HRSA regulatory requirements.

• Contributes to Healthcare succession planning initiatives. Works Collaborates closely with all manager-level leaders. across dental, medical, and operations departments.

• Oversees analytical data provided by the patient-satisfaction vendor.

Qualifications

• Bachelor's degree from an accredited college or university in nursing, health care administration, non-profit, public, or business administration and/or human/social services required.

• Master's degree is preferred from an accredited college or university.

• A minimum of five years of progressive leadership experience in healthcare operations, risk management, or quality assurance, within a Federally Qualified Health Center (FQHC) or comparable community‑based healthcare organization.

• Familiarity serving people with intellectual & developmental disabilities is desirable.

• Five years' supervisory experience required.

• Strong ability to support, lead and direct staff effectively to accomplish workplace goals required.

• Basic Life Support Certification.

• Strong oral, written, and organizational skills required.

• Knowledge of relevant federal and state regulatory requirements required.

• Knowledge of Medicare, Medicaid and third-party billing requirements required.

Physical Demands

This role primarily operates in an office environment within a healthcare facility. While performing the duties of this job, the employee is regularly required to:

• Ability to sit and stand for extended periods while working at a computer.

• Occasionally walk to different areas of the healthcare facility for meetings or other job-related needs.

• Perform light lifting related to office materials or supplies.

This position does not have any heavy physical demands.

This position may occasionally require local travel to attend meetings or site visits.