Director of Quality Assurance Equitas Health

Equitas Health does not conduct hiring through Telegram or WhatsApp and only communicates with candidates via official @equitashealth.com email addresses, requesting basic contact information only and never Social Security numbers during early hiring stages, with interviews scheduled via email and conducted through Microsoft Teams links only.

POSITION SUMMARY:

The Director of Quality Assurance will lead Equitas Health’s Quality Management program and implementation of the annual Quality Assurance plan.  QA is integrated in all aspects of business and clinical operations across the organization and owned by all providers and employees.  The Director of QA works closely with leaders and staff to build quality assurance into workflows, deploying effective education, training, communications and a regulatory change management process.  This position serves as the organization’s Compliance Officer and is responsible for ensuring the organization is compliant with federal, state and local government regulations.  This includes developing, monitoring and revision of policies and procedures that address risk management, HIPAA compliance, 340B pharmacy and other regulatory requirements.

 ESSENTIAL JOB FUNCTIONS:

Essential functions of the job include, but are not limited to local and regional travel, personnel management, leading organizational change, analytical and problem solving to direct process improvement, audit preparation, program compliance, quality outcomes and reporting, strategic planning, maintain staff and patient confidentiality, effectively manage multiple and simultaneous responsibilities, and strong communication and interpersonal skills.

Job Responsibilities:

• Co-Chairs the Quality Assurance Committee for the organization. Ensure the QA Committee provides evidence that the organization has systems in place to meet the Seven Elements of an Effective Compliance Program. Such evidence must contain trending data that is both accurate and can be used in predictive analysis.
• Create an FQHC Compliance Program that meets Section 330 of the Public Health Services Act and the requirements outlined in the Health Center Program Compliance Manual promulgated by HRSA.
• Develop and foster effective collaboration between departments and programs to ensure an integrated approach to quality, safety, and performance improvement. Communicate effectively to facilitate positive working relationships and achieve desired outcomes.
• Use an equity and social justice lens to support more equitable analyses and evaluation and bring greater awareness/understanding of the correlation between health disparities and health outcomes.
• Direct the day-to-day execution of the strategies and tactics necessary to successfully improve the outcomes and results of the organization.
• Manage organizational attestations, trainings, incident reporting, and policies.
• Implement Quality Management and Annual QA Plan(s), and provide Board of Trustee’s an Annual QA Report. Provide Board of Trustees with regular reports on health center and clinical compliance.
• Collaborate with the Chief Medical Officer in improving clinical quality measures across all service lines.  Participate in activities associated with evaluating performance in value based care.
• Create annual audit plan for high risk areas, with particular attention to billing; coding; documentation; HIPAA; investigations; cybersecurity; fraud, waste & abuse; grants management; vendor relations; and revenue protection in general.
• Participate in the development and timely review of organizational policies, procedures, and programs and provide continuing guidance to all employees on quality assurance matters that have implications for all departments.
• Collaborate across departments and update the following Operational Policies & Procedures: Compliance, HIPAA, Safety, 340B, Risk Management, Emergency Preparedness.
• Perform annual HIPAA risk assessments by ensuring the agency is in compliance with the Security Rule’s administrative, physical, and technical requirements.
• Work with Human Resources to create, implement, update, and ensure compliance with the Employee Handbook.
• Ensure systems are in place to meet compliance requirements of all federal, state and local laws, including but not limited to HIPAA, OSHA, 340B, HRSA, HUD, CDC and other regulatory guidelines, and accreditation requirements (CARF, URAC). 
• Establish an open communication environment that encourages all employees to report any suspected illegal conduct or other conduct that violates any policy or procedure, or any applicable law or regulation.
• Appropriately document and investigate incident reports submitted by employees. Provide data t