Director, Quality & Compliance

Overview

Pay Range: $129,000 - $148,468 per year

SCOPE: Develops, plans and directs the statewide compliance and quality activities at multiple locations (>12 sites; >50 physicians >400 employees) in accordance with federal, state, and local laws and regulations.

Advises the Executive Director and the Joint Policy Board regarding compliance and quality programs, issues, and policies. Recommends organizational objectives to assure the maintenance of quality patient care, ethical business practices, and continuous quality improvement. Develops and executes quality improvement programs that are in partnership with third party payors. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITES:

• Oversees the statewide compliance activities for all employees. Coordinates the review, update, and development of company compliance policies and procedures.
  
  Reports urgent information regarding potential violations of policies, procedures, or regulations to the Executive Director, Corporate Compliance and/or Policy Board immediately. Initiates corrective action and follow up after consultation with the Executive Director, Corporate Compliance, and/or Policy Board.

• Oversees the statewide quality activities for all employees. Establishes priorities for continuous quality improvement programs based on input from network management and data.

• Develops and implements practice wide quality programs. Responsible for trending, researching, analyzing and presenting statistical data pertinent to quality programs to include reports to third party payors.

• Oversees and actively direct state safety program and coordinates annual training.

• Assists practice peer review committee in data collection, analysis, and review.

• Reviews and coordinates the inclusion of professional standards of organizations such as ONS, CLIA/COLA, JCAHO, OSHA into network policies and procedures.

• Measures patient and caregiver satisfaction utilizing appropriate tools.

• Monitors employee accountability with regard to compliance by reviewing appropriate documents. Provides staff training and in-services as required.

• Utilizes USON Corporate Compliance training module when conducting annual compliance training to physicians and staff.

• In concert with USON Corporate Compliance, facilitates federal and state regulatory examinations, as appropriate. Assembles information as specified in preliminary examination requirements and furnishes required documentation to examiners.

• Acts as an examination contact on compliance matters as directed. Assists in the preparation of local responses to federal and state examination reports.

• Facilitates USON internal audit, as needed. Assembles information specified in preliminary request for documentation, and furnishes requested documentation to the practice management.

• Coordinates practice level internal audits of site facilities to ensure compliance with USON and local policy and procedures. Creates a summary report of findings and makes recommendations to local management.

• Assists in the development of new services and activities in accordance with practice objectives.

Qualifications

MINIMUM QUALIFICAITONS: Bachelor's degree in nursing or related healthcare or business field (MSN, MBA, or MHA preferred). Minimum seven years' experience in healthcare management, business office/reimbursement, compliance/regulatory affairs, and/or quality improvement initiatives.

At least three years in a supervisory capacity. Appropriate certification in risk management and/or health care compliance highly desirable.

Must have strong knowledge of reimbursement (CMS regulations), ADA, OSHA, fraud and abuse and related compliance issues. Strong knowledge of coding, billing and reimbursement (CMS regulations), ADA, OSHA, fraud and abuse and related compliance issues.

Must have a strong knowledge of medical, regulatory, legal/ethical, and human resources issues. Extensive knowledge of the various sources and resources for information at the federal, state and local level in the compliance area are highly desirable. Knowledge and understanding of statistics and the internal audit processes highly desirable.

Excellent verbal and written communication skills. Ability to work with minimal supervision and under stressful situations.

Ability to maintain and treat sensitive information with the highest level of confidentiality Ability to maintain professional interpersonal relationships with superiors, subordinates, peers and outside counsel. Computer proficiency in Microsoft Office Suite including Word, Excel, and PowerPoint required.

WORK ENVIRONMENT: 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. Requires sitting for long periods of time. Some bending and stretching required.

Adequate finger dexterity and feeling to perform keyboarding and substantial repetitive motions involving the wrists, hands, and/or fingers. Requires vision and hearing corrected to normal range. Must be able to view computer screen and printed material accurately.

Occasionally lifts and carries items up to 40 pounds. The employee is occasionally required to stand, walk, and reach with hands and arms. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The work environment is typical of an office setting but also includes potential exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment. Approximately 50% travel by automobile or airplane.